Provider Demographics
NPI:1154567139
Name:BRUUN, RENIE H (MA)
Entity type:Individual
Prefix:MRS
First Name:RENIE
Middle Name:H
Last Name:BRUUN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PERSEVERANCE WAY
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1843
Mailing Address - Country:US
Mailing Address - Phone:508-815-5125
Mailing Address - Fax:508-862-9023
Practice Address - Street 1:60 PERSEVERANCE WAY
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1843
Practice Address - Country:US
Practice Address - Phone:508-815-5125
Practice Address - Fax:508-862-9023
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health