Provider Demographics
NPI:1003183567
Name:BRYANT, VIVIAN DELORES
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:DELORES
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:V
Other - Middle Name:DELORES
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1551 FORUM PL
Mailing Address - Street 2:BUILDING 400 D & E
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2319
Mailing Address - Country:US
Mailing Address - Phone:561-616-8411
Mailing Address - Fax:561-616-8412
Practice Address - Street 1:1551 FORUM PL
Practice Address - Street 2:BUILDING 400 D & E
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2319
Practice Address - Country:US
Practice Address - Phone:561-616-8411
Practice Address - Fax:561-616-8412
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional