MEDICARE: PROF. BETTINA COLETE BRUNO-BROWN L.M.H.C.

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	103K00000X	Behavior Analyst	MH10087
2	101YM0800X	Mental Health Counselor	MH10087	FL

General Provider Information

NPI Number	:	1356652143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. BETTINA COLETE BRUNO-BROWN L.M.H.C.

Provider Business Mailing Address
First Line	:	11751 SW 3RD ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33325-2911
Country	:	US
Telephone Number	:	954-734-4708
Fax Number	:

Provider Business Practice Location Address
First Line	:	11751 SW 3RD ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33325-2911
Country	:	US
Telephone Number	:	954-734-4708
Fax Number	:

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

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	07/12/2019

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