Provider Demographics
NPI:1841553443
Name:BRUMBAUGH, MILENA ELISE (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:MILENA
Middle Name:ELISE
Last Name:BRUMBAUGH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3742
Mailing Address - Country:US
Mailing Address - Phone:419-512-4087
Mailing Address - Fax:
Practice Address - Street 1:881 HIGH ST STE 205
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4109
Practice Address - Country:US
Practice Address - Phone:614-810-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1450282-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical