Provider Demographics
NPI:1750354395
Name:BRUNETTI, STEPHEN ANTHONY (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:BRUNETTI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-0472
Mailing Address - Country:US
Mailing Address - Phone:724-845-9880
Mailing Address - Fax:724-353-1083
Practice Address - Street 1:1129 INDUSTRIAL PARK RD
Practice Address - Street 2:MAILBOX #29 STE 211
Practice Address - City:VANDERGRIFT
Practice Address - State:PA
Practice Address - Zip Code:15690
Practice Address - Country:US
Practice Address - Phone:724-845-9880
Practice Address - Fax:724-353-1083
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW013339104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001861158Medicaid
058149Medicare ID - Type Unspecified
P59654Medicare UPIN