Provider Demographics
NPI:1417469743
Name:BRULHARDT, CHRISTIE MARIE (MSED, CASAC-T)
Entity type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:MARIE
Last Name:BRULHARDT
Suffix:
Gender:
Credentials:MSED, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 TINSEL CT
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1936
Mailing Address - Country:US
Mailing Address - Phone:516-751-6138
Mailing Address - Fax:
Practice Address - Street 1:58 TINSEL CT
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1936
Practice Address - Country:US
Practice Address - Phone:516-751-6138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013959-01101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health