Provider Demographics
NPI:1396350856
Name:BRUNO, CHRISTOPHER KEVIN (LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:KEVIN
Last Name:BRUNO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 EAGLE ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-1448
Mailing Address - Country:US
Mailing Address - Phone:518-578-1398
Mailing Address - Fax:
Practice Address - Street 1:148 PARK PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3303
Practice Address - Country:US
Practice Address - Phone:718-398-1962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1512027104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker