Provider Demographics
NPI:1093854960
Name:BRYANT, DAGMAR M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DAGMAR
Middle Name:M
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:DAGMAR
Other - Middle Name:M
Other - Last Name:JELINEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:956 GRAYLEA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1412
Mailing Address - Country:US
Mailing Address - Phone:607-734-3016
Mailing Address - Fax:
Practice Address - Street 1:956 GRAYLEA CIRCLE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1412
Practice Address - Country:US
Practice Address - Phone:607-734-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR00908611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical