Provider Demographics
NPI:1851507784
Name:HOWARD, BRUCE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:HOWARD
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 1:1421 SANTA MONICA BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1750
Mailing Address - Country:US
Mailing Address - Phone:310-395-8802
Mailing Address - Fax:310-393-2528
Practice Address - Street 1:1421 SANTA MONICA BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1750
Practice Address - Country:US
Practice Address - Phone:310-395-8802
Practice Address - Fax:310-393-2528
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8275Medicare ID - Type Unspecified