Provider Demographics
NPI:1164558789
Name:BRUCATO, DOMINIC BRUCE (PHD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:BRUCE
Last Name:BRUCATO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MINDWORKS INT INC
Mailing Address - Street 2:15321 S DIXIE HWY #202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1814
Mailing Address - Country:US
Mailing Address - Phone:305-232-6463
Mailing Address - Fax:305-232-4465
Practice Address - Street 1:MINDWORKS INT INC
Practice Address - Street 2:15321 S DIXIE HWY #202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1814
Practice Address - Country:US
Practice Address - Phone:305-232-6463
Practice Address - Fax:305-232-4465
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004290103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73730OtherBCBS