Provider Demographics
NPI:1871702548
Name:BRUST, PATRICIA E (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:E
Last Name:BRUST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 MYRTLE BLVD
Mailing Address - Street 2:# 2C
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2029
Mailing Address - Country:US
Mailing Address - Phone:914-671-3454
Mailing Address - Fax:914-630-7337
Practice Address - Street 1:172 MYRTLE BLVD
Practice Address - Street 2:#2C
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2029
Practice Address - Country:US
Practice Address - Phone:914-671-3454
Practice Address - Fax:914-630-7337
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NYR 031440-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical