Provider Demographics
NPI:1083791867
Name:BRUNER, SHIRLEY JEAN (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:JEAN
Last Name:BRUNER
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 GODDARD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6960
Practice Address - Street 1:2336 GODDARD PKWY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-1126
Practice Address - Country:US
Practice Address - Phone:410-334-6961
Practice Address - Fax:410-334-6960
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD031741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD424426OtherCAREFIRST BCBS PIN
517251OtherUHC MAMSI GROUP #
724324OtherNCPPO PIN
MDLM49EAOtherCAREFIRST BCBS GROUP
DCR968OtherCAREFIRST FEDERAL GROUP
DC0011OtherCAREFIRST FEDERAL PIN
100053424001OtherAMERICAN PSYCH SYSTEM
2102153OtherUNITED HEALTH CARE MAMSI
DC0011OtherCAREFIRST FEDERAL PIN
100053424001OtherAMERICAN PSYCH SYSTEM