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General NPI Number Information
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NPI Number | 1881918852
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Entity Type | Individual
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Provider Name | VANESSA BRUGGE LCSW, BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/19/2010
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 2700 WESTHALL LN STE 248
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City | MAITLAND
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State | FL
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Zip | 32751-7203
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Country | US
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Telephone | 407-476-5825
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Fax |
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Provider Business Mailing Address
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Address Line | 6118 HEDGESPARROWS LN
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City | SANFORD
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State | FL
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Zip | 32771-6495
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Country | US
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Telephone |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1031331
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License Number State | FL
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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 | ISW15669
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW19501
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License Number State | FL
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