Provider Demographics
NPI:1881032308
Name:HARRIS-BRUNO, GAIL ANN (LBSW)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ANN
Last Name:HARRIS-BRUNO
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51790 ADLER PARK DR W
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2342
Mailing Address - Country:US
Mailing Address - Phone:586-846-7372
Mailing Address - Fax:
Practice Address - Street 1:51790 ADLER PARK DR W
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2342
Practice Address - Country:US
Practice Address - Phone:586-846-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI6802085818247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No171M00000XOther Service ProvidersCase Manager/Care Coordinator