Provider Demographics
NPI:1922644210
Name:DR. AUDREY BRUTUS PSYCHOLOGICAL SUPPORT PC
Entity Type:Organization
Organization Name:DR. AUDREY BRUTUS PSYCHOLOGICAL SUPPORT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUTUS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:347-528-7671
Mailing Address - Street 1:259 N MIDDLETOWN RD FL 2
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1220
Mailing Address - Country:US
Mailing Address - Phone:347-528-7671
Mailing Address - Fax:845-354-6501
Practice Address - Street 1:259 N MIDDLETOWN RD FL 2
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-1220
Practice Address - Country:US
Practice Address - Phone:347-528-7671
Practice Address - Fax:845-354-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health