Provider Demographics
NPI:1922776590
Name:BRUUS, CONNY (THERAPIST, LMSW)
Entity Type:Individual
Prefix:
First Name:CONNY
Middle Name:
Last Name:BRUUS
Suffix:
Gender:F
Credentials:THERAPIST, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 RICHMOND TER
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1305
Mailing Address - Country:US
Mailing Address - Phone:347-499-8901
Mailing Address - Fax:
Practice Address - Street 1:3136 RICHMOND TER
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1305
Practice Address - Country:US
Practice Address - Phone:347-499-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102879-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker