Provider Demographics
NPI:1568668630
Name:BRUNNER, JOEL STEVEN (MA)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:STEVEN
Last Name:BRUNNER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 FAIRVIEW AVE
Mailing Address - Street 2:APT. 9
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2060
Mailing Address - Country:US
Mailing Address - Phone:978-283-7198
Mailing Address - Fax:
Practice Address - Street 1:33 COMMERCIAL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5040
Practice Address - Country:US
Practice Address - Phone:978-283-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor