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General NPI Number Information
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NPI Number | 1578375671
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Entity Type | Organization
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Legal Business Name | BRILLIANT BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 438 GANTTOWN RD STE B1
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City | SEWELL
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State | NJ
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Zip | 08080-1887
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Country | US
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Telephone | 856-405-5140
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Fax |
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Provider Business Mailing Address
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Address Line | 307 SUGARMAN AVE
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City | MILLVILLE
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State | NJ
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Zip | 08332-4924
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Country | US
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Telephone | 856-405-5140
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM W BRUCK
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Credential | APRN
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Telephone | 856-405-5140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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