Provider Demographics
NPI:1861153108
Name:ALVAREZ BRUNK, MADISON NICOLE (MA, NCC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:ALVAREZ BRUNK
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 CIARA CREEK CV STE 1011
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4662
Mailing Address - Country:US
Mailing Address - Phone:407-513-2735
Mailing Address - Fax:
Practice Address - Street 1:781 CIARA CREEK CV STE 1011
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4662
Practice Address - Country:US
Practice Address - Phone:407-513-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health