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General NPI Number Information
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NPI Number | 1871702548
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Entity Type | Individual
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Provider Name | PATRICIA E BRUST LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 172 MYRTLE BLVD #2C
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City | LARCHMONT
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State | NY
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Zip | 10538-2029
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Country | US
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Telephone | 914-671-3454
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Fax | 914-630-7337
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Provider Business Mailing Address
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Address Line | 172 MYRTLE BLVD # 2C
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City | LARCHMONT
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State | NY
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Zip | 10538-2029
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Country | US
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Telephone | 914-671-3454
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Fax | 914-630-7337
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R 031440-1
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License Number State | NY
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