Provider Demographics
NPI:1396195533
Name:DINA P BRUE, LCSW, LLC
Entity Type:Organization
Organization Name:DINA P BRUE, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRUE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-643-5345
Mailing Address - Street 1:551 PARK AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1767
Mailing Address - Country:US
Mailing Address - Phone:646-643-5345
Mailing Address - Fax:
Practice Address - Street 1:551 PARK AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1767
Practice Address - Country:US
Practice Address - Phone:646-643-5345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-19
Last Update Date:2016-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055157001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty