Provider Demographics
NPI:1891991949
Name:ALBERT, BRUCE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ALBERT
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 1:3238 HUNTERDON WAY SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5002
Mailing Address - Country:US
Mailing Address - Phone:404-409-6427
Mailing Address - Fax:770-612-8095
Practice Address - Street 1:1260 CONCORD RD SE
Practice Address - Street 2:SUITE 201
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-5306
Practice Address - Country:US
Practice Address - Phone:404-409-6427
Practice Address - Fax:770-612-8096
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0011161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBFZFMedicare PIN