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NPI Code Detail

MEDICARE: SANDRA BRUNO

MEDICARE: SANDRA BRUNO
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
1101YA0400XAddiction (Substance Use Disorder) CounselorAADC169AL
2106H00000XMarriage & Family TherapistL450AL

General Provider Information

NPI Number : 1811522253
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA BRUNO
Provider Business Mailing Address
First Line : 102 WESLY CLARK BLVD
Second Line :
City : MADISON
State : AL
Zip : 35756-4028
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 102 WESLY CLARK BLVD
Second Line :
City : MADISON
State : AL
Zip : 35756-4028
Country : US
Telephone Number : 256-658-6642
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2020
Last Update Date : 03/05/2020

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Directions to “ SANDRA BRUNO ” Practice Location

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