Provider Demographics
NPI:1811398530
Name:BRUCE, MEGAN YVONNE BAILEY
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:YVONNE BAILEY
Last Name:BRUCE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:YVONNE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:470 NOOR AVE #1114
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5857
Mailing Address - Country:US
Mailing Address - Phone:408-805-4385
Mailing Address - Fax:
Practice Address - Street 1:768 MCDONELL DR
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5857
Practice Address - Country:US
Practice Address - Phone:408-805-4385
Practice Address - Fax:408-998-1535
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALCSW1074981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health