Provider Demographics
NPI:1689818999
Name:BRUNZOS, MARTHA (LMHC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:BRUNZOS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 TEN ROD RD
Mailing Address - Street 2:BUILDING C SUITE 201
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4161
Mailing Address - Country:US
Mailing Address - Phone:401-294-8181
Mailing Address - Fax:401-721-5661
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:BUILDING C SUITE 201
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4161
Practice Address - Country:US
Practice Address - Phone:401-294-8181
Practice Address - Fax:401-721-5661
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health