Individual provider · NPI-1
Nicholas Dean Brunner, LCAT
Drama Therapist · Astoria, NY
NPI number1508249434
StatusActive
Last updated in NPPESJun 21, 2022
Details
- NPI
- 1508249434
- Entity type
- Individual (NPI-1)
- Name
- Nicholas Dean Brunner
- Credential
- LCAT
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 9, 2015
- Certification date
- Jun 21, 2022
- Last updated
- Jun 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101200000X | Drama Therapist | 002096 | NY | Yes |
Practice location
4502 Ditmars Blvd Ste 1032Astoria, NY 11105-1363
Phone 718-777-6398
Mailing address
4502 Ditmars Blvd Ste 1032Astoria, NY 11105-1363
Phone 718-777-6398
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