Organization Name: | BRUCE J. RUTTENBURG, PH.D., LLC |
NPI Number: | 1174927511 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRUCE JAFFEE RUTTENBURG (MEMBER/PSYCHOLOGIST) |
Mailing Address: | 706 Columbia St Hood River |
State: | OR US |
Postal Code: | 970311720 |
Phone Number: | 5414363999 |
Fax Number: | 5414363998 |
NPI Enumeration Date: | 10/14/2014 |
NPI Last Update Date: | 10/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 1674 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |