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2421 Hollywood Blvd Suite 1 And 2 Hollywood FL 33020-6605 | |
| (954) 881-1129 | |
| (954) 923-9111 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 2421 Hollywood Blvd, Hollywood, Florida |
| Authorized Official Name and Position | Julie D Bruno (PSYCHOLOGIST) |
| Authorized Official Contact | 9548811129 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
20775 Ne 32nd Pl Aventura FL 33180-3652 Ph: (954) 881-1129 | 2421 Hollywood Blvd Suite 1 And 2 Hollywood FL 33020-6605 Ph: (954) 881-1129 |
| NPI Number | 1902074511 |
|---|---|
| Provider Enumeration Date | 02/16/2008 |
| Last Update Date | 10/23/2018 |
| Medicare PECOS PAC ID | 8123184660 |
|---|---|
| Medicare Enrollment ID | O20090306000465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902074511 | NPI | - | NPPES |
| 006521900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY7670 (Florida) | Primary |
| 251S00000X | Community/behavioral Health | PY 7670 (Florida) | Secondary |
| Provider Name | Julie Dara Bruno |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659549954 PECOS PAC ID: 3072601947 Enrollment ID: I20090304000781 |
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