Provider Demographics
NPI:1356463806
Name:BRUTON, JUDY RAKER (JD, LCSW,)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:RAKER
Last Name:BRUTON
Suffix:
Gender:F
Credentials:JD, LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 CLAYTON RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1353
Mailing Address - Country:US
Mailing Address - Phone:314-308-4356
Mailing Address - Fax:
Practice Address - Street 1:7750 CLAYTON RD
Practice Address - Street 2:SUITE 312
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1353
Practice Address - Country:US
Practice Address - Phone:314-308-4356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050194931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical