| Doctor Name: | MR. ERIC C BRUCKNER |
| NPI Number: | 1063531358 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MFTI |
| License Number: | IMF 81496 |
| Business Practice Address: | 335 E Lake Ave Watsonville, CA - 950764826 |
| Business Phone Number: | 8317286445 |
| Business Fax Number: | 8317616011 |
| Mailing Address: | 335 E Lake Ave, WATSONVILLE |
| State: | CA |
| Postal Code: | 950764826 |
| Phone Number: | 8317286445 |
| Fax Number: | 8317616011 |
| NPI Enumeration Date: | 03/28/2007 |
| NPI Last Update Date: | 08/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | IMF 81496 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |