Provider Demographics
NPI:1629762323
Name:BRUCKNER, ERICA LEIGH (AMFT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEIGH
Last Name:BRUCKNER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24814 HORSESHOE LN
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1117
Mailing Address - Country:US
Mailing Address - Phone:661-755-8662
Mailing Address - Fax:
Practice Address - Street 1:123 W GUTIERREZ ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3424
Practice Address - Country:US
Practice Address - Phone:805-965-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist