Individual
MR. JERROLD LEE BRUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1101 HILLVIEW DR, ALLENTOWN, PA 18103-6046
(610) 730-2744
Mailing address
3037 S PIKE AVE, SUITE 104, ALLENTOWN, PA 18103-7650
(610) 730-2744
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW014557
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0070975930002
—
PA
Enumeration date
08/09/2006
Last updated
04/29/2011
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