Provider Demographics
NPI:1306082672
Name:BRUNO, LUCAS FRANK III (MA)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:FRANK
Last Name:BRUNO
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40461
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89504-4461
Mailing Address - Country:US
Mailing Address - Phone:808-298-3948
Mailing Address - Fax:
Practice Address - Street 1:1995 MAIN ST STE 2J
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1706
Practice Address - Country:US
Practice Address - Phone:808-298-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-300101Y00000X
HICSAC101YA0400X
NV00500-LC101YA0400X
HIACU-372171100000X
NV01531106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171100000XOther Service ProvidersAcupuncturist