Provider Demographics
NPI:1073673943
Name:BRYANT, WILLIAM J (LICSW, CADAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:BRYANT
Suffix:
Gender:M
Credentials:LICSW, CADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3209
Mailing Address - Country:US
Mailing Address - Phone:413-536-0017
Mailing Address - Fax:
Practice Address - Street 1:367 PINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1930
Practice Address - Country:US
Practice Address - Phone:413-737-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1272AD101YA0400X
MA2123481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical