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General NPI Number Information
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NPI Number | 1730229055
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Entity Type | Individual
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Provider Name | BRUCE MERCOGLIANO PH D
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 215 HIGHLAND AVE STARTING POINT
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City | WESTMONT
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State | NJ
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Zip | 08108
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Country | US
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Telephone | 856-854-3155
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Fax |
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Provider Business Mailing Address
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Address Line | 312 EAST PARK
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City | HADDONFIELD
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State | NJ
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Zip | 08033
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Country | US
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Telephone | 856-854-3155
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Fax | 856-428-3529
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 44SW00258000
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License Number State | NJ
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