Provider Demographics
NPI:1447452230
Name:PEDIGO, BRUCE ALLEN (LCSW, LMFT, EDD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
Last Name:PEDIGO
Suffix:
Gender:M
Credentials:LCSW, LMFT, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 VILLAGE GREEN WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-3877
Mailing Address - Country:US
Mailing Address - Phone:912-381-3995
Mailing Address - Fax:850-999-2150
Practice Address - Street 1:1990 VILLAGE GREEN WAY STE 3
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-3877
Practice Address - Country:US
Practice Address - Phone:850-999-2140
Practice Address - Fax:850-999-2150
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW14551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical