Provider Demographics
NPI:1265453674
Name:FEINGOLD, BRUCE H (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:H
Last Name:FEINGOLD
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 1:1910 OLYMPIC BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5096
Mailing Address - Country:US
Mailing Address - Phone:925-945-1315
Mailing Address - Fax:925-939-4159
Practice Address - Street 1:1910 OLYMPIC BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5096
Practice Address - Country:US
Practice Address - Phone:925-945-1315
Practice Address - Fax:925-939-4159
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7464101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL74640Medicare ID - Type Unspecified