Provider Demographics
NPI:1255502472
Name:BRUCE, STEVEN EDWARD (PHD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:EDWARD
Last Name:BRUCE
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 1:7606 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3863
Mailing Address - Country:US
Mailing Address - Phone:314-516-7204
Mailing Address - Fax:314-516-7233
Practice Address - Street 1:7606 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3863
Practice Address - Country:US
Practice Address - Phone:314-516-7204
Practice Address - Fax:314-516-7233
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-15
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006020048103TC0700X
RIPS00705103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical