Provider Demographics
NPI:1003452731
Name:BRUCE, SUZANNE R
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:R
Last Name:BRUCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 S MAIN ST
Mailing Address - Street 2:28 NAISMITH STREET SPRINGFIELD MASS 01104
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3137
Mailing Address - Country:US
Mailing Address - Phone:774-250-2647
Mailing Address - Fax:617-663-6056
Practice Address - Street 1:140 GOULD ST STE 230
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2397
Practice Address - Country:US
Practice Address - Phone:774-331-8226
Practice Address - Fax:617-663-6056
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health