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General NPI Number Information
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NPI Number | 1407095185
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Entity Type | Individual
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Provider Name | DENISE E BRUSKIN-GAMBRELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 186 SUNSET AVE NW
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City | ATLANTA
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State | GA
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Zip | 30314-4059
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Country | US
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Telephone | 404-612-9336
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Fax |
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Provider Business Mailing Address
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Address Line | 5005 SADDLE BRIDGE LN
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City | ALPHARETTA
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State | GA
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Zip | 30022-8160
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Country | US
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Telephone | 770-558-2911
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Fax |
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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 | CSW003892
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License Number State | GA
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