Provider Demographics
NPI:1427308147
Name:BRUNER, PATRICIA (PHD, LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BRUNER
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1414
Mailing Address - Country:US
Mailing Address - Phone:856-383-3465
Mailing Address - Fax:856-249-3326
Practice Address - Street 1:36 KRESSON RD STE A
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3227
Practice Address - Country:US
Practice Address - Phone:856-372-0302
Practice Address - Fax:856-249-3326
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00390300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional