Provider Demographics
NPI:1144546383
Name:MUNRO-LUDDERS, BRUCE B (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:B
Last Name:MUNRO-LUDDERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:B
Other - Last Name:MUNRO-LUDDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:78 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-661-6654
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:474 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1409
Practice Address - Country:US
Practice Address - Phone:207-324-1500
Practice Address - Fax:207-490-5263
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC103371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400219041Medicare PIN