Healthcare Provider Details

I. General information

NPI: 1275938979
Provider Name (Legal Business Name): MARILYN ELIZABETH BRUNO MA, ATR-BC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 S BROAD ST UNIT 16
PHILADELPHIA PA
19145-2328
US

IV. Provider business mailing address

1930 S BROAD ST THE ART OF WELLNESS UNIT 16
PHILADELPHIA PA
19145-2328
US

V. Phone/Fax

Practice location:
  • Phone: 215-627-3339
  • Fax:
Mailing address:
  • Phone: 215-627-3339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number007833
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007833
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number007833
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number007833
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: