Provider Demographics
NPI:1932624111
Name:BRUNEAU, KAITLYN D (LCSW)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:D
Last Name:BRUNEAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 40TH ST APT 26W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2046
Mailing Address - Country:US
Mailing Address - Phone:203-654-1890
Mailing Address - Fax:
Practice Address - Street 1:125 E 23RD ST STE 402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4547
Practice Address - Country:US
Practice Address - Phone:646-650-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58.0102021041C0700X
VT089.0134869TELE1041C0700X
FLTPSW11441041C0700X
CT22271041C0700X
NJ44SC063356001041C0700X
NY0887351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical