Healthcare Provider Details

I. General information

NPI: 1851904239
Provider Name (Legal Business Name): DALIT BRUCHSTEIN LICENSED MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18542 VANDERLIP AVE STE B
SANTA ANA CA
92705-8201
US

IV. Provider business mailing address

2240 STANLEY AVE APT 12
SIGNAL HILL CA
90755-3934
US

V. Phone/Fax

Practice location:
  • Phone: 714-642-7057
  • Fax:
Mailing address:
  • Phone: 714-642-7057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberMFC45793
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: