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NPI Code Detail

MEDICARE: MS. MARY ANN BRUCE LCADC

MEDICARE: MS. MARY ANN BRUCE LCADC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCA382MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750517892
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ANN BRUCE LCADC
Provider Business Mailing Address
First Line : 8930 STANFORD BLVD
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-5805
Country : US
Telephone Number : 410-313-6281
Fax Number : 410-313-6212
Provider Business Practice Location Address
First Line : 8930 STANFORD BLVD
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-5805
Country : US
Telephone Number : 410-313-6281
Fax Number : 410-313-6212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2009
Last Update Date : 04/23/2018

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