Healthcare Provider Details

I. General information

NPI: 1871708776
Provider Name (Legal Business Name): BRUCE ANDREW SHAPIRO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S NEW ST STE 304
BETHLEHEM PA
18015-1652
US

IV. Provider business mailing address

ST. LUKE'S CVO 801 OSTRUM ST.
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-2400
  • Fax: 833-213-6428
Mailing address:
  • Phone: 484-526-8046
  • Fax: 833-213-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04509600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018692
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: