Provider Demographics
NPI:1154050243
Name:BRUNO, PAT J (LCSW)
Entity Type:Individual
Prefix:
First Name:PAT
Middle Name:J
Last Name:BRUNO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RHONDA LN
Mailing Address - Street 2:
Mailing Address - City:ROSE BUD
Mailing Address - State:AR
Mailing Address - Zip Code:72137-8003
Mailing Address - Country:US
Mailing Address - Phone:501-827-8136
Mailing Address - Fax:
Practice Address - Street 1:105 RHONDA LN
Practice Address - Street 2:
Practice Address - City:ROSE BUD
Practice Address - State:AR
Practice Address - Zip Code:72137-8003
Practice Address - Country:US
Practice Address - Phone:501-827-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9685-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR9685-COtherSTATE LICENSE