MEDICARE: MS. PATRICIA BRUCE LCSW, DCSW

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	CW 014600	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1486103	OTHER	PA	BCBS

General Provider Information

NPI Number	:	1730161266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA BRUCE LCSW, DCSW

Provider Business Mailing Address
First Line	:	4402 PEACH ST
Second Line	:	SUITE 2A
City	:	ERIE
State	:	PA
Zip	:	16509-1358
Country	:	US
Telephone Number	:	814-860-8800
Fax Number	:	814-860-8800

Provider Business Practice Location Address
First Line	:	4402 PEACH ST
Second Line	:	SUITE 2A
City	:	ERIE
State	:	PA
Zip	:	16509-1358
Country	:	US
Telephone Number	:	814-860-8800
Fax Number	:	814-860-8800

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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