Provider Demographics
NPI:1710072178
Name:BRUNO, DARRYL W (LCSW, ACSW, BACS)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:W
Last Name:BRUNO
Suffix:
Gender:M
Credentials:LCSW, ACSW, BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 DUPARD ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-3626
Mailing Address - Country:US
Mailing Address - Phone:504-451-4582
Mailing Address - Fax:
Practice Address - Street 1:2250 DUPARD ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3626
Practice Address - Country:US
Practice Address - Phone:504-451-4582
Practice Address - Fax:815-676-8210
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27401041C0700X
MSC81791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical