Provider Demographics
NPI:1528191178
Name:BRUNO, ADAM (LMFT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BRUNO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15207 MAGNOLIA BLVD UNIT 227
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1114
Mailing Address - Country:US
Mailing Address - Phone:310-488-7721
Mailing Address - Fax:
Practice Address - Street 1:4419 VAN NUYS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5738
Practice Address - Country:US
Practice Address - Phone:310-488-7721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56281106H00000X
CA080107114101YS0200X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner