Provider Demographics
NPI:1871974667
Name:BRUCE, AMY LEBOWITZ (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEBOWITZ
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 1:554 W 183RD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-8646
Mailing Address - Country:US
Mailing Address - Phone:518-775-0137
Mailing Address - Fax:
Practice Address - Street 1:554 W 183RD ST APT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-8646
Practice Address - Country:US
Practice Address - Phone:518-775-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094835-1104100000X
VT089.01352111041C0700X
NY0919171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker