Provider Demographics
NPI:1992807309
Name:ATHERTON, BRUCE CASTLE (LICSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:CASTLE
Last Name:ATHERTON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6357 JOSEPHINE AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1420
Mailing Address - Country:US
Mailing Address - Phone:952-829-7008
Mailing Address - Fax:
Practice Address - Street 1:MENTAL HEALTH COLLECTIVE
Practice Address - Street 2:3548 BRYANT AVE. S.
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408
Practice Address - Country:US
Practice Address - Phone:612-822-8227
Practice Address - Fax:612-825-4204
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN073621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical