Provider Demographics
NPI:1932849817
Name:BRUST, LIANE
Entity type:Individual
Prefix:
First Name:LIANE
Middle Name:
Last Name:BRUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SHIRE DR
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-2618
Mailing Address - Country:US
Mailing Address - Phone:347-696-0470
Mailing Address - Fax:
Practice Address - Street 1:8 SHIRE DR
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-2618
Practice Address - Country:US
Practice Address - Phone:347-696-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health