Provider Demographics
NPI:1780969519
Name:BRUCE, JAMIE LYNN (LICSW, LCSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LYNN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LICSW, LCSW, ACSW
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:COONAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:48 SEARS ISLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606
Mailing Address - Country:US
Mailing Address - Phone:215-208-1696
Mailing Address - Fax:
Practice Address - Street 1:48 SEARS ISLAND DRIVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606
Practice Address - Country:US
Practice Address - Phone:215-208-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014707101YM0800X, 1041C0700X
MA340930101YM0800X, 1041C0700X
NJ44SC0275800101YM0800X
NJ44SC012758001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health