Provider Demographics
NPI:1316357692
Name:BRUNO, MARIA (MA)
Entity type:Individual
Prefix:
First Name:MARIA
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 1:12 GERALD LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2527
Mailing Address - Country:US
Mailing Address - Phone:631-875-9229
Mailing Address - Fax:
Practice Address - Street 1:12 GERALD LN
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2527
Practice Address - Country:US
Practice Address - Phone:631-875-9229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY687455922171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator