Provider Demographics
NPI:1063940328
Name:LEBRUN, CHRISTIANISME
Entity type:Individual
Prefix:
First Name:CHRISTIANISME
Middle Name:
Last Name:LEBRUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 E 96TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1357
Mailing Address - Country:US
Mailing Address - Phone:347-303-0970
Mailing Address - Fax:
Practice Address - Street 1:839 SAINT MARKS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1539
Practice Address - Country:US
Practice Address - Phone:718-778-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor