Provider Demographics
NPI:1083639322
Name:BRUNO, CONCETTA (MA)
Entity type:Individual
Prefix:MS
First Name:CONCETTA
Middle Name:
Last Name:BRUNO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 QUAYSIDE TER APT 1605
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2220
Mailing Address - Country:US
Mailing Address - Phone:130-586-4378
Mailing Address - Fax:305-864-7114
Practice Address - Street 1:1000 QUAYSIDE TER APT 1605
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-2220
Practice Address - Country:US
Practice Address - Phone:305-864-3788
Practice Address - Fax:305-864-7114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890744700Medicaid