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Provider Information for 1134119282


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Ms. KELLI ERIN BRUNK LCSW


Sex: Female

NPI: 1134119282
Last Updated: 2007-07-08
Certification Date:

Details

NameValue
NPI1134119282
Enumeration Date2005-10-28
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 4000 NE 168 ST
#6-B
NORTH MIAMI BEACH, FL 33160-3500
United States

Phone: 786-385-6754 | Fax:305-944-6184
 
Primary Practice Address 1031 IVES DAIRY RD
STE 228
MIAMI, FL 33179-2538
United States

Phone: 786-385-6754 | Fax:305-944-6184
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalFLSW0004255