Healthcare Provider Details

I. General information

NPI: 1205040961
Provider Name (Legal Business Name): BRUCE W MEYER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115A CORAL ST
SANTA CRUZ CA
95060-2131
US

IV. Provider business mailing address

1080 EMELINE AVE HOMELESS PERSONS HEALTH PROJECT
SANTA CRUZ CA
95060-1966
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-2080
  • Fax:
Mailing address:
  • Phone: 831-454-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 17557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: