MR. BRUCE BLACK PSYCH TECH
NPI 1285185819
Licensed Psychiatric Technician in Santa Rosa, CA

Q: What is Bruce Black's NPI number?

The NPI number for Bruce Black is 1285185819. It was assigned to this individual provider in the NPPES registry on October 19, 2016.

Q: What is Bruce Black's specialty?

The primary specialty registered for this NPI is Licensed Psychiatric Technician with taxonomy code 167G00000X.

Q: When was this NPI record last updated?

The NPPES record for Bruce Black was last updated on October 19, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 19, 2016

2225 CHALLENGER WAY, SANTA ROSA, CA 95407(707) 576-8181 Get Directions Write a Review

NPPES record last updated: October 19, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Mr. Bruce Black Psych Tech NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. BRUCE BLACK PSYCH TECH (NPI 1285185819) is an individual licensed psychiatric technician in Santa Rosa, California, licensed in California (PT 31504) and active in the NPI registry since October 2016.

NPPES Registry Identity

NPI1285185819

Entity TypeIndividualMale

Primary Taxonomy167G00000X

Provider Legal NameMR. BRUCE BLACKCredential: PSYCH TECH

Location Address2225 CHALLENGER WAYSanta Rosa, CA 95407

Mailing Address2225 Challenger WaySanta Rosa, CA 95407-5441 · (707) 576-8181

Phone(707) 576-8181

Sole ProprietorYes

Enumeration DateOctober 19, 2016

✔ NPI 1285185819 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Psychiatric TechnicianNursing Service Providers

Taxonomy Code167G00000X

License✔ Licensed in CA · PT 31504

Definition

An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities.

2225 CHALLENGER WAY, Santa Rosa, CA 95407

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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