Provider Demographics
NPI:1093011041
Name:BRUNO, JUANITA CLAUDIAN (LMFT)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:CLAUDIAN
Last Name:BRUNO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 SOUTHPOINT DR S STE 450C
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0912
Mailing Address - Country:US
Mailing Address - Phone:703-618-9668
Mailing Address - Fax:
Practice Address - Street 1:6620 SOUTHPOINT DR S STE 450C
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0912
Practice Address - Country:US
Practice Address - Phone:703-618-9668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT1308106H00000X
FLMT3880106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist