Provider Demographics
NPI:1922337401
Name:BRUNNER-KISH, ESTHER KLARA (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:KLARA
Last Name:BRUNNER-KISH
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:ESTHER
Other - Middle Name:
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:4100 MITSCHER CT
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1307
Mailing Address - Country:US
Mailing Address - Phone:301-942-5168
Mailing Address - Fax:
Practice Address - Street 1:4100 MITSCHER CT
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1307
Practice Address - Country:US
Practice Address - Phone:301-942-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD084481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012745OtherPROVIDER TAXONOMY
MD110309OtherPROVIDER TAXONOMY
MD1234MAMIOtherPROVIDER TAXONOMY