Provider Demographics
NPI:1205040961
Name:MEYER, BRUCE W (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:MEYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 EMELINE AVE
Mailing Address - Street 2:HOMELESS PERSONS HEALTH PROJECT
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1966
Mailing Address - Country:US
Mailing Address - Phone:831-454-5182
Mailing Address - Fax:
Practice Address - Street 1:1080 EMELINE AVE
Practice Address - Street 2:HOMELESS PERSONS HEALTH PROJECT
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1966
Practice Address - Country:US
Practice Address - Phone:831-454-5182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
CAPSY 17557103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ91892ZOtherSANTA CRUZ COUNTY CA MEDICARE GROUP PTAN#
CAFHC 70042FOtherSANTA CRUZ COUNTY CA MEDI-CAL GROUP #
CAZZZ91891ZOtherSANTA CRUZ COUNTY CA MEDICARE GROUP PTAN#
CAFHC70044FOtherSANTA CRUZ COUNTY CA MEDI-CAL GROUP #
CAZZZ92069ZOtherSANTA CRUZ COUNTY CA MEDICARE GROUP PTAN#