Provider Demographics
NPI:1154050243
Name:BRUNO, PAT J (LCSW)
Entity type:Individual
Prefix:
First Name:PAT
Middle Name:J
Last Name:BRUNO
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RHONDA LN
Mailing Address - Street 2:
Mailing Address - City:ROSE BUD
Mailing Address - State:AR
Mailing Address - Zip Code:72137-8003
Mailing Address - Country:US
Mailing Address - Phone:501-827-8136
Mailing Address - Fax:479-763-0105
Practice Address - Street 1:105 RHONDA LN
Practice Address - Street 2:
Practice Address - City:ROSE BUD
Practice Address - State:AR
Practice Address - Zip Code:72137-8003
Practice Address - Country:US
Practice Address - Phone:501-827-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
AR9685-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
15584417OtherCAQH
AR9685COtherARKANSAS SOCIAL WORK LICENSING BOARD-LCSW
AR10-637OtherORDINATION OF MINISTER OFFICIANT
AR324450719Medicaid