Provider Demographics
NPI:1790910297
Name:CONCETTA BRUNO PA
Entity Type:Organization
Organization Name:CONCETTA BRUNO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CONCETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC
Authorized Official - Phone:305-864-3788
Mailing Address - Street 1:1000 QUAYSIDE TER APT 1605
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2220
Mailing Address - Country:US
Mailing Address - Phone:786-325-8162
Mailing Address - Fax:786-801-1199
Practice Address - Street 1:1000 QUAYSIDE TER APT 1605
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-2220
Practice Address - Country:US
Practice Address - Phone:130-586-4378
Practice Address - Fax:395-865-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty