Provider Demographics
NPI:1417960808
Name:BRUCE, JOAN A (ARNP, EDD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:A
Last Name:BRUCE
Suffix:
Gender:F
Credentials:ARNP, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 VICTORY RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-3139
Mailing Address - Country:US
Mailing Address - Phone:617-847-1950
Mailing Address - Fax:617-774-1490
Practice Address - Street 1:572 ROUTE 28
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-4909
Practice Address - Country:US
Practice Address - Phone:508-775-0719
Practice Address - Fax:508-775-5309
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA84751-PC101YP2500X
MA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1895516Medicaid
MAPK0041OtherBC-BS
MA49619OtherUBH
MABRNS0710Medicare ID - Type Unspecified
MA1895516Medicaid