Provider Demographics
NPI:1134681794
Name:BRYAN, ALISON (LMHC)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:608 FRANCESTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 HANCOCK ST FL 2
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5233
Practice Address - Country:US
Practice Address - Phone:617-293-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health