Healthcare Provider Details

I. General information

NPI: 1053642157
Provider Name (Legal Business Name): BRUCE MCCLARY LCSW, CCM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N BROADWAY PATIENT ACCOUNTING
BALTIMORE MD
21205-1832
US

IV. Provider business mailing address

2931 E BIDDLE ST PATIENT ACCOUNTING
BALTIMORE MD
21213-3939
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9400
  • Fax: 443-923-9405
Mailing address:
  • Phone: 443-923-1870
  • Fax: 443-923-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number030437
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05762
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: