Provider Demographics
NPI:1629317300
Name:BRUNA, LISA (MA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BRUNA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 NE MARTIN LUTHER KING JR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2093
Mailing Address - Country:US
Mailing Address - Phone:503-235-8057
Mailing Address - Fax:503-235-5455
Practice Address - Street 1:3500 NE MARTIN LUTHER KING JR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2093
Practice Address - Country:US
Practice Address - Phone:503-235-8057
Practice Address - Fax:503-235-5455
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health