Healthcare Provider Details

I. General information

NPI: 1124207766
Provider Name (Legal Business Name): BERNADETTE BRUNETTI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-4522
  • Fax: 954-355-5172
Mailing address:
  • Phone: 954-355-4522
  • Fax: 954-355-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW4703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: