Provider Demographics
NPI:1265785588
Name:BRUNO, JONATHAN EDWARD (BCBA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:EDWARD
Last Name:BRUNO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 W RUMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0155
Mailing Address - Country:US
Mailing Address - Phone:209-222-2378
Mailing Address - Fax:209-579-9494
Practice Address - Street 1:2825 W RUMBLE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0185
Practice Address - Country:US
Practice Address - Phone:209-222-2378
Practice Address - Fax:209-579-9494
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-6985103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst