Provider Demographics
NPI:1881102994
Name:BRUNDAGE, EMILY (LMSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BRUNDAGE
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 ABBOT RD STE 400
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1900
Mailing Address - Country:US
Mailing Address - Phone:517-325-3505
Mailing Address - Fax:517-882-3633
Practice Address - Street 1:1400 ABBOT RD STE 400
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1900
Practice Address - Country:US
Practice Address - Phone:517-325-3505
Practice Address - Fax:517-882-3633
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011123831041C0700X, 1041C0700X
CAASW84204101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)