Provider Demographics
NPI:1841473279
Name:BRUDER, RONALD LAWRENCE (LCSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LAWRENCE
Last Name:BRUDER
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 1:2996 NC 69 STE 6
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-7258
Mailing Address - Country:US
Mailing Address - Phone:828-389-1795
Mailing Address - Fax:828-389-1658
Practice Address - Street 1:2996 NC 69 STE 6
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-7258
Practice Address - Country:US
Practice Address - Phone:828-389-1795
Practice Address - Fax:828-389-1658
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health