Provider Demographics
NPI:1851483853
Name:TONY BRUDER, PH D & ASSOCIATES P C
Entity Type:Organization
Organization Name:TONY BRUDER, PH D & ASSOCIATES P C
Other - Org Name:BRUDER COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRUDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-498-9320
Mailing Address - Street 1:289 INDEPENDENCE BLVD
Mailing Address - Street 2:STE 221
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-498-9320
Mailing Address - Fax:757-498-9321
Practice Address - Street 1:289 INDEPENDENCE BLVD
Practice Address - Street 2:STE 221
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-498-9320
Practice Address - Fax:757-498-9321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA340992OtherTRICARE GROUP PROVIDER #
VA340992OtherTRICARE GROUP PROVIDER #