Provider Demographics
NPI:1043447345
Name:ADAMS, BRUCE III
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ADAMS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2804
Mailing Address - Country:US
Mailing Address - Phone:650-458-0026
Mailing Address - Fax:650-548-0027
Practice Address - Street 1:1108 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2804
Practice Address - Country:US
Practice Address - Phone:650-458-0026
Practice Address - Fax:650-548-0027
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT80838106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist