Provider Demographics
NPI:1184151334
Name:BRUZAS, MAIJA BROOX (PHD)
Entity type:Individual
Prefix:MRS
First Name:MAIJA
Middle Name:BROOX
Last Name:BRUZAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 MARKET ST STE 3108
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3313
Mailing Address - Country:US
Mailing Address - Phone:215-898-4793
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST STE 3108
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3313
Practice Address - Country:US
Practice Address - Phone:215-898-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical