Provider Demographics
NPI:1528601432
Name:BRUNO-MATLAK, JESSICA MARIA (MWS)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIA
Last Name:BRUNO-MATLAK
Suffix:
Gender:F
Credentials:MWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 CLAWSON ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4211
Mailing Address - Country:US
Mailing Address - Phone:347-581-6995
Mailing Address - Fax:
Practice Address - Street 1:585 CLAWSON ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4211
Practice Address - Country:US
Practice Address - Phone:347-581-6995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker