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General NPI Number Information
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NPI Number | 1902788169
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Entity Type | Organization
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Legal Business Name | STEPHENIE AUSTIN-BRUSATTE LCSW PLLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 206 N RANDOLPH ST STE 412
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3978
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Country | US
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Telephone | 765-280-3032
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Fax |
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Provider Business Mailing Address
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Address Line | 206 N RANDOLPH ST STE 412
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3978
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Country | US
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Telephone | 765-280-3032
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHENIE AUSTIN-BRUSATTE
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Credential | LCSW
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Telephone | 217-840-1475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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