Provider Demographics
NPI:1730161266
Name:BRUCE, PATRICIA (LCSW, DCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 PEACH ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1358
Mailing Address - Country:US
Mailing Address - Phone:814-860-8800
Mailing Address - Fax:814-860-8800
Practice Address - Street 1:4402 PEACH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1358
Practice Address - Country:US
Practice Address - Phone:814-860-8800
Practice Address - Fax:814-860-8800
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW 0146001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1486103OtherBCBS
PA082128Medicare ID - Type Unspecified
PA1486103OtherBCBS