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: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE ML 3015
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVENUE ML 3015
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4336
  • Fax: 513-636-7756
Mailing address:
  • Phone: 513-636-4336
  • Fax: 513-636-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP.08242
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: