Provider Demographics
NPI:1497917835
Name:PARKER, BRUCE SHEA (MA, LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:SHEA
Last Name:PARKER
Suffix:
Gender:M
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1839
Mailing Address - Country:US
Mailing Address - Phone:845-679-5464
Mailing Address - Fax:
Practice Address - Street 1:48 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1839
Practice Address - Country:US
Practice Address - Phone:845-679-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0702081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical