Provider Demographics
NPI:1538474705
Name:KINCAID BRUUN, ANA M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:M
Last Name:KINCAID BRUUN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:M
Other - Last Name:KINCAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:70 COX STREET
Mailing Address - Street 2:UNIT 7
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749
Mailing Address - Country:US
Mailing Address - Phone:978-854-2435
Mailing Address - Fax:978-937-8695
Practice Address - Street 1:53 MERRIAM AVE.
Practice Address - Street 2:UNIT 4
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-513-2396
Practice Address - Fax:978-937-8695
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1195301041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker