Provider Demographics
NPI:1598154874
Name:BRUZIK, KELLI HITCHENS (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:HITCHENS
Last Name:BRUZIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:HITCHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:319 JOHN HANCOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN UNIVERSITY
Mailing Address - State:PA
Mailing Address - Zip Code:19352-9311
Mailing Address - Country:US
Mailing Address - Phone:302-383-2675
Mailing Address - Fax:
Practice Address - Street 1:314 E MAIN ST STE 402
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7182
Practice Address - Country:US
Practice Address - Phone:302-636-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00013391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical