Provider Demographics
NPI:1043301187
Name:DEVEAU, BRUCE EDWARD (LICSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:EDWARD
Last Name:DEVEAU
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PLEASANT ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2606
Mailing Address - Country:US
Mailing Address - Phone:978-462-3287
Mailing Address - Fax:978-462-3287
Practice Address - Street 1:42 PLEASANT ST
Practice Address - Street 2:SUITE 7
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2606
Practice Address - Country:US
Practice Address - Phone:978-462-3287
Practice Address - Fax:978-462-3287
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1114891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23134Medicare ID - Type Unspecified