Provider Demographics
NPI:1124473319
Name:BRUCE, MARIA (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 STUYVESANT OVAL
Mailing Address - Street 2:APT 10 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2212
Mailing Address - Country:US
Mailing Address - Phone:917-651-6386
Mailing Address - Fax:
Practice Address - Street 1:12 STUYVESANT OVAL
Practice Address - Street 2:APT 10 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2212
Practice Address - Country:US
Practice Address - Phone:917-651-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007014-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health