Provider Demographics
NPI:1407826936
Name:ALBERT, BRUCE MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:ALBERT
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 1:2120 TULPEHOCKEN RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1018
Mailing Address - Country:US
Mailing Address - Phone:610-376-4890
Mailing Address - Fax:
Practice Address - Street 1:400 PINE BROOK PL
Practice Address - Street 2:SUITE4
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-2350
Practice Address - Country:US
Practice Address - Phone:570-366-3739
Practice Address - Fax:570-366-3708
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004891-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAL612875OtherHIGHMARK BLUE SHIELD
PA01969502OtherCAPITAL BLUE CROSS
PA01969502OtherCAPITAL BLUE CROSS