Provider Demographics
NPI:1619909272
Name:BRUNO, PAULA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAULA
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 1:66 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5667
Mailing Address - Country:US
Mailing Address - Phone:718-761-4614
Mailing Address - Fax:718-983-0348
Practice Address - Street 1:1358 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4303
Practice Address - Country:US
Practice Address - Phone:718-761-4614
Practice Address - Fax:718-983-0348
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN38131Medicare ID - Type UnspecifiedLCSW