Active NPI
Kory Brudzinski
- Mental Health Counselor
- Fort Lauderdale, FL
National Provider Identifier
1497062988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH1263
- Practice address
- 3800 W Broward Blvd Ste 100
Fort Lauderdale, FL 33312-1018 - Phone
- (954) 587-1008
- Fax
- (954) 587-0080
- NPI assigned
- Sep 7, 2010
- Last updated
- Jan 16, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH1263 | FL | Primary |
Addresses
Primary practice location
3800 W Broward Blvd Ste 100
Fort Lauderdale, FL 33312-1018
Mailing address
3800 W Broward Blvd Ste 100
Fort Lauderdale, FL 33312-1018
Phone (954) 587-1008
Other practice location 1
1800 Mercy Dr
Suite 302
Orlando, FL 32808-5646
Phone (407) 875-3700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH1263 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chrysalis Center, LLC | Past | Accepting new patients | |
| Aspire Health Partners, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Orlando, FL
- NPI 1821033903
-
dba Chrysalis Health
- Community/Behavioral Health Agency
- Fort Lauderdale, FL
- NPI 1700961646
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579132800000",
"number": "1497062988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3800 W BROWARD BLVD STE 100",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333121018",
"telephone_number": "954-587-1008",
"fax_number": "954-587-0080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 W BROWARD BLVD STE 100",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333121018",
"telephone_number": "954-587-1008",
"fax_number": "954-587-0080"
}
],
"practiceLocations": [
{
"address_1": "1800 Mercy Dr",
"address_2": "Suite 302",
"address_purpose": "LOCATION",
"city": "Orlando",
"state": "FL",
"postal_code": "328085646",
"country_code": "US",
"telephone_number": "407-875-3700",
"fax_number": "407-522-4671",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRUDZINSKI",
"first_name": "KORY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-07",
"last_updated": "2020-01-16",
"certification_date": "2020-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH1263",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.