Provider Demographics
NPI:1902074511
Name:JULIE D BRUNO PA
Entity Type:Organization
Organization Name:JULIE D BRUNO PA
Other - Org Name:INFINITE BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-881-1129
Mailing Address - Street 1:20775 NE 32ND PL
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3652
Mailing Address - Country:US
Mailing Address - Phone:954-881-1129
Mailing Address - Fax:954-923-9190
Practice Address - Street 1:2421 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 1 AND 2
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6605
Practice Address - Country:US
Practice Address - Phone:954-881-1129
Practice Address - Fax:954-923-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-16
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7670103TC0700X
FLPY 7670251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006521900Medicaid