Active NPI
Eric C Bruckner, MFTI
- Mental Health Counselor
- Watsonville, CA
National Provider Identifier
1063531358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- IMF 81496
- Practice address
- 335 E Lake Ave
Watsonville, CA 95076-4826 - Phone
- (831) 728-6445
- Fax
- (831) 761-6011
- NPI assigned
- Mar 28, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IMF 81496 | CA | Primary |
Addresses
Primary practice location
335 E Lake Ave
Watsonville, CA 95076-4826
Mailing address
335 E Lake Ave
Watsonville, CA 95076-4826
Phone (831) 728-6445
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IMF 81496 | Other | CA | BOARD BEHAVIORAL SCIENCES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMF 81496 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409270400000",
"number": "1063531358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "335 E LAKE AVE",
"city": "WATSONVILLE",
"state": "CA",
"postal_code": "950764826",
"telephone_number": "831-728-6445",
"fax_number": "831-761-6011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "335 E LAKE AVE",
"city": "WATSONVILLE",
"state": "CA",
"postal_code": "950764826",
"telephone_number": "831-728-6445",
"fax_number": "831-761-6011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCKNER",
"first_name": "ERIC",
"middle_name": "C",
"name_prefix": "Mr.",
"credential": "MFTI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-28",
"last_updated": "2014-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "IMF 81496",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD BEHAVIORAL SCIENCES",
"identifier": "IMF 81496",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Watsonville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.