Healthcare Provider Details

I. General information

NPI: 1235710153
Provider Name (Legal Business Name): AMANDA BRUENING PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 WRIGHT ST
WESTPORT CT
06880-3100
US

IV. Provider business mailing address

8 WRIGHT ST
WESTPORT CT
06880-3100
US

V. Phone/Fax

Practice location:
  • Phone: 203-800-2056
  • Fax:
Mailing address:
  • Phone: 203-800-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number026399
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005007
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08242
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: