Provider Demographics
NPI:1851544019
Name:BRUNDAGE, LAURA ELLEN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:BRUNDAGE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BERR BRUNDAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:8 WRIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5146
Mailing Address - Country:US
Mailing Address - Phone:845-227-1962
Mailing Address - Fax:845-223-3829
Practice Address - Street 1:8 WRIGHT BLVD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-5146
Practice Address - Country:US
Practice Address - Phone:845-227-1962
Practice Address - Fax:845-223-3829
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO42597-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical