Provider Demographics
NPI:1215149505
Name:PITHER, BRUCE FRASER (PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:FRASER
Last Name:PITHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 MOLIMO DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1622
Mailing Address - Country:US
Mailing Address - Phone:415-694-0254
Mailing Address - Fax:415-334-6433
Practice Address - Street 1:514 MOLIMO DR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1622
Practice Address - Country:US
Practice Address - Phone:415-694-0254
Practice Address - Fax:415-334-6433
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical