Provider Demographics
NPI:1871708776
Name:SHAPIRO, BRUCE ANDREW (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ANDREW
Last Name:SHAPIRO
Suffix:
Gender:M
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:ST. LUKE'S CVO
Mailing Address - Street 2:801 OSTRUM ST.
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-8046
Mailing Address - Fax:833-213-6428
Practice Address - Street 1:306 S NEW ST STE 304
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1652
Practice Address - Country:US
Practice Address - Phone:484-526-2400
Practice Address - Fax:833-213-6428
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045096001041C0700X
PACW0186921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0020371Medicaid