Healthcare Provider Details

I. General information

NPI: 1558315457
Provider Name (Legal Business Name): CHRISTIE TERRELL DEBRUCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MORNINGSTAR RD APT C
STATEN ISLAND NY
10303-2862
US

IV. Provider business mailing address

7723 16TH AVE
BROOKLYN NY
11214-1001
US

V. Phone/Fax

Practice location:
  • Phone: 929-427-1749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010099
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP061641-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06202500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: