Provider Demographics
NPI:1659557015
Name:BRUNNER, VERENA LISA (MSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:VERENA
Middle Name:LISA
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 LONGSHORE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1634
Mailing Address - Country:US
Mailing Address - Phone:734-663-2621
Mailing Address - Fax:
Practice Address - Street 1:1812 LONGSHORE DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1634
Practice Address - Country:US
Practice Address - Phone:734-663-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010052951041C0700X
MI4101005094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0891277Medicare PIN