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General NPI Number Information
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NPI Number | 1134119282
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Entity Type | Individual
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Provider Name | KELLI ERIN BRUNK LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1031 IVES DAIRY RD STE 228
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City | MIAMI
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State | FL
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Zip | 33179-2538
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Country | US
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Telephone | 786-385-6754
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Fax | 305-944-6184
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Provider Business Mailing Address
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Address Line | 4000 NE 168 ST #6-B
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-3500
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Country | US
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Telephone | 786-385-6754
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Fax | 305-944-6184
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW0004255
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License Number State | FL
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