MEDICARE: MS. SUSAN MERRILL BRUCE LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1025767	MA

General Provider Information

NPI Number	:	1114033644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN MERRILL BRUCE LICSW

Provider Business Mailing Address
First Line	:	285 HARVARD ST
Second Line	:	#211
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-2335
Country	:	US
Telephone Number	:	617-661-1996
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 PORTER ST
Second Line	:
City	:	EAST BOSTON
State	:	MA
Zip	:	02128-2116
Country	:	US
Telephone Number	:	617-912-7575
Fax Number	:	617-569-7890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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