Individual
NICHOLAS DEAN BRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAT
Contact information
Practice address
4502 DITMARS BLVD STE 1032, ASTORIA, NY 11105-1363
(718) 777-6398
Mailing address
4502 DITMARS BLVD STE 1032, ASTORIA, NY 11105-1363
(718) 777-6398
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
Primary
002096
NY
Other
Enumeration date
07/09/2015
Last updated
06/21/2022
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