Provider Demographics
NPI:1801305792
Name:SCOTT-BRUNER, MARLENE ADELE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:ADELE
Last Name:SCOTT-BRUNER
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 1:1099 MOSS GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-7453
Mailing Address - Country:US
Mailing Address - Phone:630-222-5588
Mailing Address - Fax:
Practice Address - Street 1:1099 MOSS GROVE DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-7453
Practice Address - Country:US
Practice Address - Phone:219-250-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-24
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009450A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical