Nicholas Dean Brunner, LCAT

Primary specialty

Drama TherapistTaxonomy code 101200000X

License

002096 Issued in NY

Practice address

4502 Ditmars Blvd Ste 1032
Astoria, NY 11105-1363

Phone

(718) 777-6398

NPI assigned

Jul 9, 2015

Last updated

Jun 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1508249434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4502 DITMARS BLVD STE 1032",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111051363",
            "telephone_number": "718-777-6398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 DITMARS BLVD STE 1032",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111051363",
            "telephone_number": "718-777-6398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNNER",
        "first_name": "NICHOLAS",
        "middle_name": "DEAN",
        "credential": "LCAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-09",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101200000X",
            "taxonomy_group": "",
            "desc": "Drama Therapist",
            "state": "NY",
            "license": "002096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Drama Therapist in Astoria, NY
• Providers in Astoria, NY by specialty
• Drama Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.