Provider Demographics
NPI:1679877112
Name:BRUTUS, AUDREY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:BRUTUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BRANCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1048
Mailing Address - Country:US
Mailing Address - Phone:347-528-7671
Mailing Address - Fax:845-517-0737
Practice Address - Street 1:259 N MIDDLETOWN RD
Practice Address - Street 2:FL 2
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-1220
Practice Address - Country:US
Practice Address - Phone:212-684-0099
Practice Address - Fax:866-696-7991
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-24
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018897103TC0700X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical