MEDICARE: BRUCE ADIN GUNTHER MS,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
1	1041C0700X	Clinical Social Worker	8973 CP-S	SC
2	1041C0700X	Clinical Social Worker	LICSW 209	RI
3	106H00000X	Marriage & Family Therapist	LIMFT 23 (INACTIVE)	RI

General Provider Information

NPI Number	:	1710134150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE ADIN GUNTHER MS,MSW,

Provider Business Mailing Address
First Line	:	1645 ETTERS LN
Second Line	:
City	:	CASSATT
State	:	SC
Zip	:	29032-9265
Country	:	US
Telephone Number	:	803-425-7178
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 ETTERS LN
Second Line	:
City	:	CASSATT
State	:	SC
Zip	:	29032-9265
Country	:	US
Telephone Number	:	803-425-7178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	08/27/2008

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