Provider Demographics
NPI:1790712289
Name:BRUNER, MARTIN D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:D
Last Name:BRUNER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5539
Mailing Address - Country:US
Mailing Address - Phone:718-345-5000
Mailing Address - Fax:718-345-5794
Practice Address - Street 1:259 BRISTOL ST FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5540
Practice Address - Country:US
Practice Address - Phone:718-345-5000
Practice Address - Fax:718-732-2548
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0726711041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
WI331058Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
WI331944Medicare Oscar/Certification
WI331978Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331947Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
WI331945Medicare Oscar/Certification