Provider Demographics
NPI:1437766177
Name:BRUDNER, DANIELLE (MS)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BRUDNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CYGNET RD
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1790
Mailing Address - Country:US
Mailing Address - Phone:845-642-7021
Mailing Address - Fax:
Practice Address - Street 1:18 CYGNET RD
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-1790
Practice Address - Country:US
Practice Address - Phone:845-642-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY713391131103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool