Provider Demographics
NPI:1023038445
Name:BRUNO, RICHARD L (HD PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:BRUNO
Suffix:
Gender:M
Credentials:HD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 PROSPECT AVE
Mailing Address - Street 2:17A
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2209
Mailing Address - Country:US
Mailing Address - Phone:201-342-6777
Mailing Address - Fax:201-342-6777
Practice Address - Street 1:151 PROSPECT AVE
Practice Address - Street 2:17A
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2209
Practice Address - Country:US
Practice Address - Phone:201-342-6777
Practice Address - Fax:201-342-6777
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100280500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S20375Medicare UPIN
NJ855989Medicare ID - Type Unspecified