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General NPI Number Information
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NPI Number | 1619902152
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Entity Type | Individual
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Provider Name | BETSY ANN BRUGLER L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 104 S PARK WAY # B
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City | SANTA CRUZ
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State | CA
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Zip | 95062-2202
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Country | US
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Telephone | 831-429-5151
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Fax | 831-429-5151
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Provider Business Mailing Address
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Address Line | 102 ALTA AVE
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City | SANTA CRUZ
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State | CA
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Zip | 95060-6438
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Country | US
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Telephone | 831-429-5151
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Fax | 831-429-5151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 14698
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCS 14690
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License Number State | CA
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