Provider Demographics
NPI:1295432896
Name:HELLER, BRUCE WARREN (PHD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:WARREN
Last Name:HELLER
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 1:2 FIFER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1174
Mailing Address - Country:US
Mailing Address - Phone:415-717-1085
Mailing Address - Fax:415-329-2806
Practice Address - Street 1:2 FIFER AVE STE 200
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1174
Practice Address - Country:US
Practice Address - Phone:415-717-1085
Practice Address - Fax:415-329-2806
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8002103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical