MEDICARE: ORIANA CHRISTINA BRUNO LLP

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	103TC1900X	Counseling Psychologist	6301012311	MI

General Provider Information

NPI Number	:	1871610261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORIANA CHRISTINA BRUNO LLP

Provider Business Mailing Address
First Line	:	827 SHADYBROOK DR
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-1603
Country	:	US
Telephone Number	:	616-399-6975
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 BALL AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5904
Country	:	US
Telephone Number	:	616-456-6571
Fax Number	:	616-456-5800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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