MEDICARE: STEPHEN ANTHONY BRUNETTI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	CW013339	PA
2	1041C0700X	Clinical Social Worker	CW013339	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750354395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN ANTHONY BRUNETTI LCSW

Provider Business Mailing Address
First Line	:	PO BOX 472
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-0472
Country	:	US
Telephone Number	:	724-845-9880
Fax Number	:	724-353-1083

Provider Business Practice Location Address
First Line	:	1129 INDUSTRIAL PARK RD
Second Line	:	MAILBOX #29 STE 211
City	:	VANDERGRIFT
State	:	PA
Zip	:	15690
Country	:	US
Telephone Number	:	724-845-9880
Fax Number	:	724-353-1083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	07/01/2008

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