MEDICARE: LAURA BRUCO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1588309223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA BRUCO, LLC

Provider Business Mailing Address
First Line	:	1037 NE 65TH ST UNIT 80213
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-6655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 28TH AVE SW APT 3
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-2565
Country	:	US
Telephone Number	:	206-705-3101
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	LAURA MAY BRUCO
Credential	:	MSW, LSWAIC
Telephone Number	:	206-705-3101

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	04/27/2022

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