Provider Demographics
NPI:1629553326
Name:DAVIDSON, BRUCE N (LICSW)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:N
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SARATOGA CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7414
Mailing Address - Country:US
Mailing Address - Phone:908-295-3763
Mailing Address - Fax:
Practice Address - Street 1:31 SARATOGA CT
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-7414
Practice Address - Country:US
Practice Address - Phone:908-295-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1002151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical