Provider Demographics
NPI:1609928316
Name:BRUZZESE, DONNA THOMAS (MA, LPCC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:THOMAS
Last Name:BRUZZESE
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 12TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1820
Mailing Address - Country:US
Mailing Address - Phone:505-246-9096
Mailing Address - Fax:
Practice Address - Street 1:400 12TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1820
Practice Address - Country:US
Practice Address - Phone:505-246-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional