Provider Demographics
NPI:1326106832
Name:NEUSTADTER, BRUCE (MFT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:NEUSTADTER
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 1:710 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2748
Mailing Address - Country:US
Mailing Address - Phone:831-423-4566
Mailing Address - Fax:
Practice Address - Street 1:710 RIVER ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2748
Practice Address - Country:US
Practice Address - Phone:831-423-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMV17498106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMV17498OtherSTATE LICENSE