Provider Demographics
NPI:1053145151
Name:BRUCK, MARIAN
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:BRUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2223
Mailing Address - Country:US
Mailing Address - Phone:419-774-9969
Mailing Address - Fax:419-756-5642
Practice Address - Street 1:34 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2236
Practice Address - Country:US
Practice Address - Phone:567-743-7199
Practice Address - Fax:419-756-5642
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician