Provider Demographics
NPI:1093294183
Name:BRUIN, ELEANOR LACY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:LACY
Last Name:BRUIN
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 1:2381 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6004
Mailing Address - Country:US
Mailing Address - Phone:303-902-9362
Mailing Address - Fax:
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE 260
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:303-902-9362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099236511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical