Provider Demographics
NPI:1154474146
Name:BRUNING, PAMELA SEAVEY (LICSW, BCD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SEAVEY
Last Name:BRUNING
Suffix:
Gender:F
Credentials:LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 OSSIPEE RD
Mailing Address - Street 2:
Mailing Address - City:CAPE NEDDICK
Mailing Address - State:ME
Mailing Address - Zip Code:03902-7158
Mailing Address - Country:US
Mailing Address - Phone:207-361-2555
Mailing Address - Fax:207-361-2556
Practice Address - Street 1:14 STRING BRG
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-1835
Practice Address - Country:US
Practice Address - Phone:603-772-6553
Practice Address - Fax:207-361-2556
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH111041C0700X
MA1064541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007507Medicaid