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NPI Code Detail

MEDICARE: MRS. LORRAINE BRUCE BSW

MEDICARE: MRS. LORRAINE BRUCE BSW
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
1104100000XSocial WorkerFL

General Provider Information

NPI Number : 1609814276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LORRAINE BRUCE BSW
Provider Business Mailing Address
First Line : PO BOX 6115
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-0115
Country : US
Telephone Number : 850-871-0455
Fax Number : 850-871-0456
Provider Business Practice Location Address
First Line : 6909 E HIGHWAY 22
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-2370
Country : US
Telephone Number : 850-871-0455
Fax Number : 850-871-0456
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2006
Last Update Date : 07/09/2007

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Directions to “ MRS. LORRAINE BRUCE BSW” Practice Location

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