Provider Demographics
NPI:1215684873
Name:HELLER, BRUCE ALLAN (PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLAN
Last Name:HELLER
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 1:1417 26TH ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3053
Mailing Address - Country:US
Mailing Address - Phone:818-687-3065
Mailing Address - Fax:310-453-8881
Practice Address - Street 1:1417 26TH ST UNIT C
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3053
Practice Address - Country:US
Practice Address - Phone:818-687-3065
Practice Address - Fax:310-453-8881
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical