Provider Demographics
NPI:1083047252
Name:BRUN, JUDITH MYRNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:MYRNA
Last Name:BRUN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 BEACH 9TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5636
Mailing Address - Country:US
Mailing Address - Phone:718-686-3149
Mailing Address - Fax:347-695-9701
Practice Address - Street 1:156 BEACH 9TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5636
Practice Address - Country:US
Practice Address - Phone:718-686-3149
Practice Address - Fax:347-695-9701
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054864-11041C0700X
NY085267-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical