MEDICARE: MRS. MAIJA BROOX BRUZAS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS018939	PA

General Provider Information

NPI Number	:	1184151334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAIJA BROOX BRUZAS PHD

Provider Business Mailing Address
First Line	:	3535 MARKET ST STE 3108
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3313
Country	:	US
Telephone Number	:	215-898-4793
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 MARKET ST STE 3108
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3313
Country	:	US
Telephone Number	:	215-898-4793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2017
Last Update Date	:	12/05/2019

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