Bruce Black, PSYCH TECH

Primary specialty

Licensed Psychiatric TechnicianTaxonomy code 167G00000X

License

PT 31504 Issued in CA

Practice address

2225 Challenger Way
Santa Rosa, CA 95407

Phone

(707) 576-8181

NPI assigned

Oct 19, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1285185819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 CHALLENGER WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954075441",
            "telephone_number": "707-576-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 CHALLENGER WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95407",
            "telephone_number": "707-576-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "BRUCE",
        "name_prefix": "Mr.",
        "credential": "PSYCH TECH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-19",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "PT 31504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destiny Madison Bittner
• Katrina J Bivin
• Judith Claire Bjorndal, M.D.
• Kelsey Renee Bjugstad, ASW
• BKD Arbors of Santa Rosa, LLC (Brookdale Chanate)
• Denise Black
• Kate Esther Black, MD
• Delbert Lee Blackburn
• Blackwell Homes
• Bradley Thomas Blackwell

• Licensed Psychiatric Technician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Licensed Psychiatric Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.