Healthcare Provider Details

I. General information

NPI: 1750354395
Provider Name (Legal Business Name): STEPHEN ANTHONY BRUNETTI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 INDUSTRIAL PARK RD MAILBOX #29 STE 211
VANDERGRIFT PA
15690
US

IV. Provider business mailing address

PO BOX 472
NATRONA HEIGHTS PA
15065-0472
US

V. Phone/Fax

Practice location:
  • Phone: 724-845-9880
  • Fax: 724-353-1083
Mailing address:
  • Phone: 724-845-9880
  • Fax: 724-353-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCW013339
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013339
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001861158
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: