Provider Demographics
NPI:1083767743
Name:BRYANT, VALERIE L (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:L
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 CARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4604
Mailing Address - Country:US
Mailing Address - Phone:718-643-2496
Mailing Address - Fax:718-855-0523
Practice Address - Street 1:290 CARLTON
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205
Practice Address - Country:US
Practice Address - Phone:718-643-2496
Practice Address - Fax:718-855-0523
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR017676103TP0814X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N2525Medicare UPIN