Provider Demographics
NPI:1184813826
Name:BRUZINSKI, CHRISTINE DWYER (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DWYER
Last Name:BRUZINSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 REGENT TERRRACE,
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4950
Mailing Address - Country:US
Mailing Address - Phone:204-400-1178
Mailing Address - Fax:
Practice Address - Street 1:755 MAIN ST
Practice Address - Street 2:BUILDING 8
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468
Practice Address - Country:US
Practice Address - Phone:203-400-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT753018Medicaid