Provider Demographics
NPI:1154571115
Name:BRUINING, MI OK SONG (MSW)
Entity type:Individual
Prefix:MS
First Name:MI OK
Middle Name:SONG
Last Name:BRUINING
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4342
Mailing Address - Country:US
Mailing Address - Phone:508-347-8462
Mailing Address - Fax:
Practice Address - Street 1:825 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4342
Practice Address - Country:US
Practice Address - Phone:401-347-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1216751041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical