Provider Demographics
NPI:1639392624
Name:REID, BRUCE G (LICSW, LCSW-C)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:G
Last Name:REID
Suffix:
Gender:M
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 DROGUE CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4328
Mailing Address - Country:US
Mailing Address - Phone:410-268-2647
Mailing Address - Fax:
Practice Address - Street 1:1901 D ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2534
Practice Address - Country:US
Practice Address - Phone:202-698-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3030861041C0700X
MD084221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical