Provider Demographics
NPI:1437142015
Name:BRUNER, LYNN A (PHD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:BRUNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1307
Mailing Address - Country:US
Mailing Address - Phone:570-748-1850
Mailing Address - Fax:
Practice Address - Street 1:315 N GROVE ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1307
Practice Address - Country:US
Practice Address - Phone:570-748-1850
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS01528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092246Medicare ID - Type UnspecifiedPSYCHOLOGIST