Provider Demographics
NPI:1730229055
Name:MERCOGLIANO, BRUCE (PH D)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:MERCOGLIANO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 EAST PARK
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033
Mailing Address - Country:US
Mailing Address - Phone:856-854-3155
Mailing Address - Fax:856-428-3529
Practice Address - Street 1:215 HIGHLAND AVE
Practice Address - Street 2:STARTING POINT
Practice Address - City:WESTMONT
Practice Address - State:NJ
Practice Address - Zip Code:08108
Practice Address - Country:US
Practice Address - Phone:856-854-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW00258000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist