MEDICARE: ALYSSA FAITH VENTURA BRUNKEN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1629308036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA FAITH VENTURA BRUNKEN LCSW

Provider Business Mailing Address
First Line	:	11237 GALLERY ECHO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-6052
Country	:	US
Telephone Number	:	702-738-9780
Fax Number	:

Provider Business Practice Location Address
First Line	:	5043 BELL LOOP
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-2940
Country	:	US
Telephone Number	:	702-738-9780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	05/18/2022

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