Provider Demographics
NPI:1497877120
Name:EGGLESTON, BRUCE A (PSYD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9653
Mailing Address - Country:US
Mailing Address - Phone:413-323-8269
Mailing Address - Fax:
Practice Address - Street 1:20 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9653
Practice Address - Country:US
Practice Address - Phone:413-323-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical