Provider Demographics
NPI:1518029271
Name:DIGRUCCIO, BRENDA LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:DIGRUCCIO
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 1:33866 PEQUITO DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2482
Mailing Address - Country:US
Mailing Address - Phone:949-489-1463
Mailing Address - Fax:949-489-7778
Practice Address - Street 1:21632 WESLEY DR
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-8167
Practice Address - Country:US
Practice Address - Phone:949-499-5346
Practice Address - Fax:949-499-1594
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS213641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical