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General NPI Number Information
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NPI Number | 1871998849
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Entity Type | Individual
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Provider Name | TERESA BRUNO
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Gender | Female
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 42469 GARFIELD RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1651
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Country | US
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Telephone | 586-239-8985
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Fax | 586-477-4781
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Provider Business Mailing Address
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Address Line | 8609 KENNEDY CIR K5
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City | WARREN
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State | MI
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Zip | 48093-2236
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Country | US
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Telephone | 586-219-2276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801093443
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License Number State | MI
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