Provider Demographics
NPI:1114940624
Name:GURGANUS, BRUCE FRASER (MFT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:FRASER
Last Name:GURGANUS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 CRESTON RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1503
Mailing Address - Country:US
Mailing Address - Phone:415-499-7595
Mailing Address - Fax:415-499-3791
Practice Address - Street 1:20 N SAN PEDRO RD STE 2021
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4158
Practice Address - Country:US
Practice Address - Phone:415-499-6769
Practice Address - Fax:415-499-3791
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 16879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health