Provider Demographics
NPI:1255402434
Name:LODING, BRUCE VERN (PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:VERN
Last Name:LODING
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 1:1227 SOUTH ST
Mailing Address - Street 2:P.O. BOX 98
Mailing Address - City:BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01005-8907
Mailing Address - Country:US
Mailing Address - Phone:978-355-2506
Mailing Address - Fax:
Practice Address - Street 1:42 PATTON ROAD
Practice Address - Street 2:
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432
Practice Address - Country:US
Practice Address - Phone:978-796-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4792101YM0800X
MA8949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health