Healthcare Provider Details

I. General information

NPI: 1891889366
Provider Name (Legal Business Name): DANIEL J. BRUCE L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TULLY RD SUITE C-1
MODESTO CA
95350-0836
US

IV. Provider business mailing address

3300 TULLY RD SUITE C-1
MODESTO CA
95350-0836
US

V. Phone/Fax

Practice location:
  • Phone: 209-529-2084
  • Fax: 209-529-2282
Mailing address:
  • Phone: 209-529-2084
  • Fax: 209-529-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS13251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: