1376031120 NPI number — MR. THOMAS ALFRED BRUNO PSYCHOLOGIST

Table of content: MR. THOMAS ALFRED BRUNO PSYCHOLOGIST (NPI 1376031120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376031120 NPI number — MR. THOMAS ALFRED BRUNO PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNO
Provider First Name:
THOMAS
Provider Middle Name:
ALFRED
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PSYCHOLOGIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376031120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2888 E. LONG LAKE RD.
Provider Second Line Business Mailing Address:
SUITE 145
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-765-8448
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2888 E. LONG LAKE RD.
Provider Second Line Business Practice Location Address:
SUITE 145
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-765-8448
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  63001008433 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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