Provider Demographics
NPI:1316408958
Name:BRUNNER, RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BRUNNER
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 1:501 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-9453
Mailing Address - Country:US
Mailing Address - Phone:814-502-4433
Mailing Address - Fax:
Practice Address - Street 1:767 SCOTCH VALLEY RD STE 3A
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-6601
Practice Address - Country:US
Practice Address - Phone:814-502-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135978104100000X
PACW0217401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker