Provider Demographics
NPI:1609814276
Name:BRUCE, LORRAINE (BSW)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:BSW
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 6115
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-0115
Mailing Address - Country:US
Mailing Address - Phone:850-871-0455
Mailing Address - Fax:850-871-0456
Practice Address - Street 1:6909 E HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-2370
Practice Address - Country:US
Practice Address - Phone:850-871-0455
Practice Address - Fax:850-871-0456
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker