Basic Information
| Provider Information | |||||||||
| NPI: | 1154571115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUINING | ||||||||
| FirstName: | MI OK | ||||||||
| MiddleName: | SONG | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 SHAW RD | ||||||||
| Address2: | P O BOX 333 | ||||||||
| City: | LITTLE COMPTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028371518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086765708 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 66 TROY ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027203023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086765708 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2008 | ||||||||
| LastUpdateDate: | 09/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.