Provider Demographics
NPI:1447038195
Name:BRUCE, LA SHAWN ALVETTA (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:LA SHAWN
Middle Name:ALVETTA
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 MARLBORO WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20623-1228
Mailing Address - Country:US
Mailing Address - Phone:646-294-5724
Mailing Address - Fax:
Practice Address - Street 1:10300 MARLBORO WOODS DR
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:MD
Practice Address - Zip Code:20623-1228
Practice Address - Country:US
Practice Address - Phone:646-294-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD283371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical