Provider Demographics
NPI:1871982496
Name:BRUNET, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BRUNET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 BRIDGE ST
Mailing Address - Street 2:APT 5
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1775
Mailing Address - Country:US
Mailing Address - Phone:860-593-1242
Mailing Address - Fax:
Practice Address - Street 1:126 BRIDGE ST
Practice Address - Street 2:APT 5
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1775
Practice Address - Country:US
Practice Address - Phone:860-593-1242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor