Provider Demographics
NPI:1669795357
Name:SORIANO BRUCHER, CARMEN GLORIA (MA, LAMFT)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:GLORIA
Last Name:SORIANO BRUCHER
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:MISS
Other - First Name:CARMEN
Other - Middle Name:GLORIA
Other - Last Name:SORIANO BRUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16210 39TH PL N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-1354
Mailing Address - Country:US
Mailing Address - Phone:763-694-0380
Mailing Address - Fax:
Practice Address - Street 1:804 LAKE ST E
Practice Address - Street 2:SUITE 204
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1980
Practice Address - Country:US
Practice Address - Phone:763-269-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist