Provider Demographics
NPI:1164845392
Name:BRYANT, AHMAD A (CAP)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:A
Last Name:BRYANT
Suffix:
Gender:M
Credentials:CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 SE 6TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483
Mailing Address - Country:US
Mailing Address - Phone:561-251-7404
Mailing Address - Fax:561-423-3804
Practice Address - Street 1:258 SE 6TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483
Practice Address - Country:US
Practice Address - Phone:561-265-5951
Practice Address - Fax:561-423-3804
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4683101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)