Provider Demographics
NPI:1659549954
Name:BRUNO, JULIE DARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:DARA
Last Name:BRUNO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20775 NE 32ND PL
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3652
Mailing Address - Country:US
Mailing Address - Phone:954-881-1129
Mailing Address - Fax:954-923-9190
Practice Address - Street 1:2421 HOLLYWOOD BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020
Practice Address - Country:US
Practice Address - Phone:305-240-6157
Practice Address - Fax:954-923-9190
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7670103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006521900Medicaid
FLPTAN BK184YMedicare PIN