Healthcare Provider Details

I. General information

NPI: 1750955258
Provider Name (Legal Business Name): KRISTEN BRUNO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

30 BEECHER ST APT 314
PAWTUCKET RI
02860-1887
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-2500
  • Fax:
Mailing address:
  • Phone: 518-892-3916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: