Provider Demographics
NPI:1104343136
Name:BRUCE, BRITNEY SHALE (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:BRITNEY
Middle Name:SHALE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:BRITNEY
Other - Middle Name:SHALE
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4179 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-1505
Mailing Address - Country:US
Mailing Address - Phone:513-574-1205
Mailing Address - Fax:513-574-1206
Practice Address - Street 1:4179 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1505
Practice Address - Country:US
Practice Address - Phone:513-574-1205
Practice Address - Fax:513-574-1206
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1701041104100000X
OHI.2203667104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker