Healthcare Provider Details

I. General information

NPI: 1366654766
Provider Name (Legal Business Name): BRUCE MICHAEL ECKER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 CHESTNUT ST SUITE 12
SPRINGFIELD MA
01107-1610
US

IV. Provider business mailing address

780 CHESTNUT ST SUITE 12
SPRINGFIELD MA
01107-1610
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-8445
  • Fax: 413-733-8429
Mailing address:
  • Phone: 413-733-8445
  • Fax: 413-733-8429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6377
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6377
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6377
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number6377
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: