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NPI Code Detail

MEDICARE: MR. DAVID ROBERT BRUCE LCSW, MSW

MEDICARE: MR. DAVID ROBERT BRUCE LCSW, MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerC004665NC
21041C0700XClinical Social WorkerC004665NC

General Provider Information

NPI Number : 1073896767
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID ROBERT BRUCE LCSW, MSW
Provider Business Mailing Address
First Line : PO BOX 24458
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27114-4458
Country : US
Telephone Number : 336-659-8202
Fax Number : 336-659-8206
Provider Business Practice Location Address
First Line : 1311 WESTBROOK PLAZA DR
Second Line : SUITE 100
City : WINSTON SALEM
State : NC
Zip : 27103-1327
Country : US
Telephone Number : 336-659-8202
Fax Number : 336-659-8206
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2011
Last Update Date : 09/20/2011

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