Provider Demographics
NPI:1588309223
Name:LAURA BRUCO, LLC
Entity type:Organization
Organization Name:LAURA BRUCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:BRUCO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSWAIC
Authorized Official - Phone:206-705-3101
Mailing Address - Street 1:1037 NE 65TH ST UNIT 80213
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4101 28TH AVE SW APT 3
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2565
Practice Address - Country:US
Practice Address - Phone:206-705-3101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health