Provider Demographics
NPI:1942054028
Name:BRUS, ADINA S
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:S
Last Name:BRUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 AVE OF THE STATES
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4789
Mailing Address - Country:US
Mailing Address - Phone:800-604-2273
Mailing Address - Fax:
Practice Address - Street 1:1500 AVE OF THE STATES
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4789
Practice Address - Country:US
Practice Address - Phone:800-604-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-24-72449103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst