Provider Demographics
NPI:1093092991
Name:BRUNK, PATTY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:PATTY
Middle Name:
Last Name:BRUNK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7799 PASSER RD
Mailing Address - Street 2:
Mailing Address - City:BLOSSVALE
Mailing Address - State:NY
Mailing Address - Zip Code:13308-2225
Mailing Address - Country:US
Mailing Address - Phone:315-533-5208
Mailing Address - Fax:
Practice Address - Street 1:293 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-3804
Practice Address - Country:US
Practice Address - Phone:315-272-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7619276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health