Provider Demographics
NPI:1720695919
Name:MYERS, ALBERT BRUCE IV
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:BRUCE
Last Name:MYERS
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 ASH ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3663
Mailing Address - Country:US
Mailing Address - Phone:508-840-5819
Mailing Address - Fax:
Practice Address - Street 1:139 ASH ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3663
Practice Address - Country:US
Practice Address - Phone:508-840-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor