Provider Demographics
NPI:1801931852
Name:BRUNO, SAMUEL J (MFT)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:J
Last Name:BRUNO
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4514
Mailing Address - Country:US
Mailing Address - Phone:619-593-6072
Mailing Address - Fax:
Practice Address - Street 1:270 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4514
Practice Address - Country:US
Practice Address - Phone:619-593-6072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist