Provider Demographics
NPI:1376031120
Name:BRUNO, THOMAS ALFRED (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALFRED
Last Name:BRUNO
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2888 E. LONG LAKE RD.
Mailing Address - Street 2:SUITE 145
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085
Mailing Address - Country:US
Mailing Address - Phone:248-765-8448
Mailing Address - Fax:
Practice Address - Street 1:2888 E. LONG LAKE RD.
Practice Address - Street 2:SUITE 145
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085
Practice Address - Country:US
Practice Address - Phone:248-765-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63001008433103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical