Provider Demographics
NPI:1104936434
Name:BRUNO, GREG MARTIN (PHD AND LCSW)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:MARTIN
Last Name:BRUNO
Suffix:
Gender:M
Credentials:PHD AND LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 FRONT ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4535
Mailing Address - Country:US
Mailing Address - Phone:831-588-7299
Mailing Address - Fax:
Practice Address - Street 1:740 FRONT ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4535
Practice Address - Country:US
Practice Address - Phone:831-588-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14956103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist