Provider Demographics
NPI:1831270958
Name:BRUCE, MARILYN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 MADRUGA AVE
Mailing Address - Street 2:SUITE 306B
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3148
Mailing Address - Country:US
Mailing Address - Phone:305-661-0440
Mailing Address - Fax:305-668-2330
Practice Address - Street 1:1450 MADRUGA AVE
Practice Address - Street 2:SUITE 306B
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3148
Practice Address - Country:US
Practice Address - Phone:305-661-0440
Practice Address - Fax:305-668-2330
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00033391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8579Medicaid
FLZ8579Medicaid