Provider Demographics
NPI:1013091016
Name:BRUSKO, MARLENE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:
Last Name:BRUSKO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 BEACON DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3834
Mailing Address - Country:US
Mailing Address - Phone:847-991-9996
Mailing Address - Fax:
Practice Address - Street 1:814 BEACON DR
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3834
Practice Address - Country:US
Practice Address - Phone:847-991-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71003717103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL957910Medicare ID - Type Unspecified