Provider Demographics
NPI:1366654766
Name:ECKER, BRUCE MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:ECKER
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 1:780 CHESTNUT ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1610
Mailing Address - Country:US
Mailing Address - Phone:413-733-8445
Mailing Address - Fax:413-733-8429
Practice Address - Street 1:780 CHESTNUT ST
Practice Address - Street 2:SUITE 12
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1610
Practice Address - Country:US
Practice Address - Phone:413-733-8445
Practice Address - Fax:413-733-8429
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6377103G00000X, 103TC0700X, 103TC2200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO236595OtherMBC CORPORATION
MA792894OtherTUFTS HEALTH PLAN
MAW05829OtherBLUE CROSS BLUE SHIELD
UT87726OtherUNITED BEHAVIORAL HEALTH
CTP3447893OtherOXFORD HEALTH PLANS
MAW05829OtherBLUE CROSS BLUE SHIELD