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General NPI Number Information
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NPI Number | 1245599661
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Entity Type | Organization
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Legal Business Name | BRUCE L. STAFFORD, PA
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 631 N HYER AVE
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City | ORLANDO
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State | FL
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Zip | 32803-4629
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Country | US
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Telephone | 407-648-9118
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Fax | 407-865-5432
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Provider Business Mailing Address
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Address Line | 631 N HYER AVE
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City | ORLANDO
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State | FL
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Zip | 32803-4629
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Country | US
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Telephone | 407-648-9118
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Fax | 407-865-5432
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Authorized Official
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Title or Position | LILCENSED CLINICAL SOCAIL WORKER
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Name | MR. BRUCE L. STAFFORD
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Credential | LCSW
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Telephone | 407-648-9118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW1618
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License Number State | FL
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