Provider Demographics
NPI:1750493995
Name:PRUNEDA, ROBERTO JR (REGISTERED COUNSLOR)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:PRUNEDA
Suffix:JR
Gender:M
Credentials:REGISTERED COUNSLOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E MAIN ST STE 600
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1146
Mailing Address - Country:US
Mailing Address - Phone:509-488-4074
Mailing Address - Fax:509-488-0166
Practice Address - Street 1:425 E MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1146
Practice Address - Country:US
Practice Address - Phone:509-488-4074
Practice Address - Fax:509-488-0166
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00055505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health