Provider Demographics
NPI:1144750480
Name:BRUNS, KATRINA MAGDALENE (MSW, LCSW, LISW)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:MAGDALENE
Last Name:BRUNS
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3563 SIERRA DEL SOL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-0767
Mailing Address - Country:US
Mailing Address - Phone:563-513-8076
Mailing Address - Fax:
Practice Address - Street 1:3563 SIERRA DEL SOL AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-0767
Practice Address - Country:US
Practice Address - Phone:563-513-8076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087293104100000X
NMC-117851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker