Provider Demographics
NPI:1821199050
Name:HARDWICK, BRUCE EDMOND (LMSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:EDMOND
Last Name:HARDWICK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 COCHISE ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-3506
Mailing Address - Country:US
Mailing Address - Phone:928-445-3496
Mailing Address - Fax:
Practice Address - Street 1:500 N HIGHWAY 89
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:928-776-6138
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1953SW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker