Provider Demographics
NPI:1962615336
Name:BRUCKER, MARY CATHERINE (LSCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:BRUCKER
Suffix:
Gender:
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31821 159TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-6470
Mailing Address - Country:US
Mailing Address - Phone:913-775-3663
Mailing Address - Fax:913-351-3797
Practice Address - Street 1:508 CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-2626
Practice Address - Country:US
Practice Address - Phone:913-775-3663
Practice Address - Fax:913-351-3797
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099316021041C0700X
KS23511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical