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General NPI Number Information
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NPI Number | 1891889366
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Entity Type | Individual
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Provider Name | DANIEL J. BRUCE L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 3300 TULLY RD SUITE C-1
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City | MODESTO
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State | CA
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Zip | 95350-0836
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Country | US
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Telephone | 209-529-2084
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Fax | 209-529-2282
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Provider Business Mailing Address
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Address Line | 3300 TULLY RD SUITE C-1
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City | MODESTO
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State | CA
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Zip | 95350-0836
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Country | US
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Telephone | 209-529-2084
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Fax | 209-529-2282
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LCS13251
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License Number State | CA
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