Provider Demographics
NPI:1720571888
Name:SERRANO-BRUNSON, NAOMI BRIANNE
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:BRIANNE
Last Name:SERRANO-BRUNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 PONY TRACKS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3062
Mailing Address - Country:US
Mailing Address - Phone:719-654-4143
Mailing Address - Fax:
Practice Address - Street 1:3680 PONY TRACKS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3062
Practice Address - Country:US
Practice Address - Phone:719-654-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
CORBT-18-57904106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician