Provider Demographics
NPI:1386914539
Name:RUESCHENBERG, ERICH (PHD)
Entity type:Individual
Prefix:DR
First Name:ERICH
Middle Name:
Last Name:RUESCHENBERG
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:PO BOX 2386
Mailing Address - Street 2:
Mailing Address - City:AVILA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93424-2386
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6215 PLAYA VISTA PLACE
Practice Address - Street 2:
Practice Address - City:AVILA BEACH
Practice Address - State:CA
Practice Address - Zip Code:93424-2386
Practice Address - Country:US
Practice Address - Phone:805-595-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13790103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist