Individual provider Active NPI

Darryl W Bruno, LCSW, ACSW, BACS

  • Clinical Social Worker
  • Mandeville, LA
National Provider Identifier
1710072178
Registry record updated Dec 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2740 Issued in LA
Practice address
2250 Dupard St
Mandeville, LA 70448-3626
Phone
(504) 451-4582
Fax
(815) 676-8210
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2740 LA Primary
Clinical Social Worker 1041C0700X C8179 MS

Addresses

Primary practice location

2250 Dupard St
Mandeville, LA 70448-3626

Mailing address

2250 Dupard St
Mandeville, LA 70448-3626
Phone (504) 451-4582

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150514001925 MS Practitioner - Clinical Social Worker 4486974409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1987
Medicare assignment
May accept Medicare assignment
Group practices
Bruno Counseling and Consulting Services, LLCGroup PAC ID 0749500767, 2 clinicians

Practice addresses (Care Compare)

110 W Erlanger St
Poplarville, MS 39470-3009
Phone (601) 746-5125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2740LAMDClinical Social Worker
C8179MSMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bruno Counseling and Consulting Services, LLC Clinical CurrentSince Apr 5, 2015 Accepting new patients

Locations

110 W Erlanger St
Poplarville, MS 39470
Phone (601) 746-5125

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417478400000",
    "number": "1710072178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 DUPARD ST",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704483626",
            "telephone_number": "504-451-4582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2250 DUPARD ST",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704483626",
            "telephone_number": "504-451-4582",
            "fax_number": "815-676-8210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNO",
        "first_name": "DARRYL",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "LCSW, ACSW, BACS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2014-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "2740",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C8179",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandeville, LA

Sources for this page

Verify at the official NPI Registry.