Provider Demographics
NPI:1891889366
Name:BRUCE, DANIEL J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:BRUCE
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 1:3300 TULLY RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0836
Mailing Address - Country:US
Mailing Address - Phone:209-529-2084
Mailing Address - Fax:209-529-2282
Practice Address - Street 1:3300 TULLY RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0836
Practice Address - Country:US
Practice Address - Phone:209-529-2084
Practice Address - Fax:209-529-2282
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS132511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28089ZMedicare ID - Type Unspecified