Provider Demographics
NPI:1568512606
Name:SAUL, BRUCE EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:EDWARD
Last Name:SAUL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:SHELTER ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11964-0367
Mailing Address - Country:US
Mailing Address - Phone:631-871-9933
Mailing Address - Fax:631-749-2052
Practice Address - Street 1:222 MANOR PL
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944-1261
Practice Address - Country:US
Practice Address - Phone:631-871-9933
Practice Address - Fax:631-749-2052
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN6H381Medicare ID - Type Unspecified