Healthcare Provider Details

I. General information

NPI: 1780969519
Provider Name (Legal Business Name): JAMIE LYNN BRUCE LICSW, LCSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. JAMIE LYNN COONAN

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 SEARS ISLAND DRIVE
WORCESTER MA
01606
US

IV. Provider business mailing address

48 SEARS ISLAND DRIVE
WORCESTER MA
01606
US

V. Phone/Fax

Practice location:
  • Phone: 215-208-1696
  • Fax:
Mailing address:
  • Phone: 215-208-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014707
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC01275800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121613
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: