Provider Demographics
NPI:1609573153
Name:WLOSINSKI, BRUCE CHESTER
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:CHESTER
Last Name:WLOSINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-2037
Mailing Address - Country:US
Mailing Address - Phone:323-523-1302
Mailing Address - Fax:
Practice Address - Street 1:1957 MAGNOLIA CIR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-2037
Practice Address - Country:US
Practice Address - Phone:323-523-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical