Provider Demographics
NPI:1649412685
Name:BRUNI, ROBERTA MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:MARIE
Last Name:BRUNI
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 1:11795 DAUPHIN AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33778-2908
Mailing Address - Country:US
Mailing Address - Phone:716-481-8271
Mailing Address - Fax:
Practice Address - Street 1:11795 DAUPHIN AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33778-2908
Practice Address - Country:US
Practice Address - Phone:716-481-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL007873-2015101YA0400X
FLSW 123471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)