Provider Demographics
NPI:1588135040
Name:BRUCE, ROBERT ERNEST JR (LSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ERNEST
Last Name:BRUCE
Suffix:JR
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1785 BIG HILL RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-2219
Mailing Address - Country:US
Mailing Address - Phone:937-264-0084
Mailing Address - Fax:937-264-0095
Practice Address - Street 1:2081 DRUMMOND DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-4023
Practice Address - Country:US
Practice Address - Phone:937-264-0084
Practice Address - Fax:937-264-0095
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1101315104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker