Individual
DR. BRUCE EDWARD NERENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(800) 360-8387
(260) 460-1481
Mailing address
5017 BRIGHT ANGEL TRL, FORT WAYNE, IN 46808-2973
(414) 526-2040
(260) 444-2208
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
057-1860
WI
103TC0700X
Clinical Psychologist
Primary
20042163A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39112100
—
WI
Enumeration date
08/01/2006
Last updated
03/29/2013
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