Provider Demographics
NPI:1124606454
Name:BRUHNS, ALICE H (LMSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:H
Last Name:BRUHNS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 BAY RD STE 204
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-3005
Mailing Address - Country:US
Mailing Address - Phone:518-952-9032
Mailing Address - Fax:
Practice Address - Street 1:375 BAY RD STE 204
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3005
Practice Address - Country:US
Practice Address - Phone:518-952-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1356819221Medicaid