Provider Demographics
NPI:1134294861
Name:BRYANT, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 MONTAGUE ST
Mailing Address - Street 2:SUITE 418
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3610
Mailing Address - Country:US
Mailing Address - Phone:718-875-7510
Mailing Address - Fax:718-643-3455
Practice Address - Street 1:189 MONTAGUE ST
Practice Address - Street 2:SUITE 436
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3610
Practice Address - Country:US
Practice Address - Phone:718-875-5625
Practice Address - Fax:718-875-6876
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0248361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical