Provider Demographics
NPI:1003342338
Name:ASTON, BRYAN T JR (LCSW)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:T
Last Name:ASTON
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 NW 55TH BLVD APT 308
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3785
Mailing Address - Country:US
Mailing Address - Phone:917-485-9664
Mailing Address - Fax:
Practice Address - Street 1:5300 NW 55TH BLVD APT 308
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3785
Practice Address - Country:US
Practice Address - Phone:917-485-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0895661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical