Provider Demographics
NPI:1750935482
Name:BRUNO HARROLD, GANIA
Entity type:Individual
Prefix:
First Name:GANIA
Middle Name:
Last Name:BRUNO HARROLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8362 PINES BLVD STE 196
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6600
Mailing Address - Country:US
Mailing Address - Phone:754-368-3134
Mailing Address - Fax:
Practice Address - Street 1:2033 HOLLYWOOD BLVD STE 201
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4509
Practice Address - Country:US
Practice Address - Phone:754-368-3134
Practice Address - Fax:954-206-8782
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW160711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical