Provider Demographics
NPI:1003887530
Name:BRUCE-WATTS, CHERYL (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:BRUCE-WATTS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 W. BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5299
Mailing Address - Country:US
Mailing Address - Phone:410-601-2318
Mailing Address - Fax:410-601-2982
Practice Address - Street 1:2434 W. BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5299
Practice Address - Country:US
Practice Address - Phone:410-601-2318
Practice Address - Fax:410-601-2982
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR056431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health