Provider Demographics
NPI:1568231504
Name:BRUFF, TACAYA EBONY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TACAYA
Middle Name:EBONY
Last Name:BRUFF
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3305
Mailing Address - Country:US
Mailing Address - Phone:860-282-8882
Mailing Address - Fax:
Practice Address - Street 1:531 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3305
Practice Address - Country:US
Practice Address - Phone:860-282-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7351104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker