Provider Demographics
NPI:1255470696
Name:ALTMAN, BRUCE (PSY'D)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:PSY'D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARKET ST UNIT 1G
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3456
Mailing Address - Country:US
Mailing Address - Phone:603-427-1428
Mailing Address - Fax:603-431-5538
Practice Address - Street 1:500 MARKET ST UNIT 1G
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3456
Practice Address - Country:US
Practice Address - Phone:603-427-1428
Practice Address - Fax:603-431-5538
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH491103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME141800000Medicaid
NH3076310Medicaid
ME141800000Medicaid