Provider Demographics
NPI:1205433869
Name:BRUNO, JACLYN (LMSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:BRUNO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15755 17TH RD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3253
Mailing Address - Country:US
Mailing Address - Phone:516-714-4206
Mailing Address - Fax:
Practice Address - Street 1:41A W MERRICK RD STE 2
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5708
Practice Address - Country:US
Practice Address - Phone:516-500-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY94346104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker