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General NPI Number Information
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NPI Number | 1902435472
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Entity Type | Individual
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Provider Name | BRUCE LAMBERT ROSS LMFT
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Gender | Male
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 501 MISSION ST STE 103
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City | SANTA CRUZ
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State | CA
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Zip | 95060-3687
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Country | US
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Telephone | 831-459-9329
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Fax | 831-471-5202
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Provider Business Mailing Address
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Address Line | 1148 WESTERN DR
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City | SANTA CRUZ
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State | CA
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Zip | 95060-2359
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Country | US
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Telephone | 831-212-9170
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC34853
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License Number State | CA
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