Provider Demographics
NPI:1679268338
Name:BRUKNER, BRANDI (LPC)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:BRUKNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 VAN BUREN DR
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2509
Mailing Address - Country:US
Mailing Address - Phone:724-980-4054
Mailing Address - Fax:
Practice Address - Street 1:2858 OLD FREEPORT RD
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1900
Practice Address - Country:US
Practice Address - Phone:724-980-4054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PCO13319101YM0800X
PAPCO13319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty