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General NPI Number Information
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NPI Number | 1457619157
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Entity Type | Individual
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Provider Name | ELIANA M DEANGELIS BRUNNER LPAT
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Gender | Female
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 3630 DUTCHMANS LN FL 2
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City | LOUISVILLE
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State | KY
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Zip | 40205-3216
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Country | US
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Telephone | 502-523-7565
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Fax |
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Provider Business Mailing Address
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Address Line | 2306 WOODBOURNE AVE APT 5
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City | LOUISVILLE
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State | KY
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Zip | 40205-1754
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Country | US
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Telephone | 502-523-7565
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | KY-0126
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License Number State | KY
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