Provider Demographics
NPI:1316507965
Name:BRUCE, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 BRAZIL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2121
Mailing Address - Country:US
Mailing Address - Phone:415-966-8723
Mailing Address - Fax:
Practice Address - Street 1:709 BRAZIL AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2121
Practice Address - Country:US
Practice Address - Phone:415-966-8723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF8131180OtherDO NOT REPORT THE MEDICARE NUMBERS, SOCIAL SECURITY NUMBER (SSN), IRS INDIVIDUAL