Provider Demographics
NPI:1912262569
Name:BRUNNER, BRIANNA PEARL (LCSW)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:PEARL
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 FRANKLIN CORNER ROAD
Mailing Address - Street 2:SUITE B210
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2527
Mailing Address - Country:US
Mailing Address - Phone:732-804-4314
Mailing Address - Fax:
Practice Address - Street 1:168 FRANKLIN CORNER RD
Practice Address - Street 2:SUITE B210
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2529
Practice Address - Country:US
Practice Address - Phone:732-804-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL056333001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical