Healthcare Provider Details

I. General information

NPI: 1255502472
Provider Name (Legal Business Name): STEVEN EDWARD BRUCE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2008
Last Update Date: 03/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7606 MARYLAND AVE
SAINT LOUIS MO
63105-3863
US

IV. Provider business mailing address

7606 MARYLAND AVE
SAINT LOUIS MO
63105-3863
US

V. Phone/Fax

Practice location:
  • Phone: 314-516-7204
  • Fax: 314-516-7233
Mailing address:
  • Phone: 314-516-7204
  • Fax: 314-516-7233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2006020048
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS00705
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: