Provider Demographics
NPI:1295792844
Name:HERSEY, BRUCE (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:HERSEY
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 1:217 UNION AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3247
Mailing Address - Country:US
Mailing Address - Phone:814-944-3852
Mailing Address - Fax:814-943-2022
Practice Address - Street 1:217 UNION AVE
Practice Address - Street 2:FL 2
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-3247
Practice Address - Country:US
Practice Address - Phone:814-944-3852
Practice Address - Fax:814-943-2022
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2018-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000343L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000571887OtherHIGHMARK/ BLUE SHIELD
109661OtherVALUEOPTIONS