Provider Demographics
NPI:1467552174
Name:BRUNO, DEBORAH (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
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 1:3400 NE 192ND ST
Mailing Address - Street 2:PH LP10
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2462
Mailing Address - Country:US
Mailing Address - Phone:305-905-7177
Mailing Address - Fax:305-792-0217
Practice Address - Street 1:2627 NE 203RD ST
Practice Address - Street 2:SUITE 211
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1900
Practice Address - Country:US
Practice Address - Phone:305-905-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6832103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ011LOtherBLUE CROSS BLUE SHIELD
FLE8011Medicare ID - Type UnspecifiedMEDICARE
FLK7551Medicare ID - Type UnspecifiedMEDICARE