Provider Demographics
NPI:1346487386
Name:SPIEGEL, BRONWYN GROESBECK (MS, MFT)
Entity Type:Individual
Prefix:MS
First Name:BRONWYN
Middle Name:GROESBECK
Last Name:SPIEGEL
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7260 CALLE CRISTOBAL
Mailing Address - Street 2:#45
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6062
Mailing Address - Country:US
Mailing Address - Phone:858-353-3896
Mailing Address - Fax:858-695-0611
Practice Address - Street 1:5190 GOVERNOR DR
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2847
Practice Address - Country:US
Practice Address - Phone:858-353-5896
Practice Address - Fax:858-695-0611
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist