Provider Demographics
NPI:1740304898
Name:KERBER, BRUCE L (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:L
Last Name:KERBER
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 FREMONT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1122
Mailing Address - Country:US
Mailing Address - Phone:612-822-1357
Mailing Address - Fax:612-822-1360
Practice Address - Street 1:1516 W LAKE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2554
Practice Address - Country:US
Practice Address - Phone:612-822-1357
Practice Address - Fax:612-822-1360
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
6253217OtherUBH
8G483KEOtherBCBS