Provider Demographics
NPI:1922119809
Name:HINER, BRUCE GERARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:GERARD
Last Name:HINER
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 1:120 PLEASANT HILL AVE N STE 340
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3168
Mailing Address - Country:US
Mailing Address - Phone:707-329-6942
Mailing Address - Fax:844-276-4833
Practice Address - Street 1:120 PLEASANT HILL AVE N STE 340
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3168
Practice Address - Country:US
Practice Address - Phone:707-329-6942
Practice Address - Fax:844-276-4833
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19229103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical