Healthcare Provider Details

I. General information

NPI: 1699689984
Provider Name (Legal Business Name): JANISE NATASHA BRUTUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 GREENLAND AVE
EWING NJ
08638-3630
US

IV. Provider business mailing address

208 GREENLAND AVE
EWING NJ
08638-3630
US

V. Phone/Fax

Practice location:
  • Phone: 724-863-7223
  • Fax: 724-863-8320
Mailing address:
  • Phone: 724-863-7223
  • Fax: 724-863-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: