Provider Demographics
NPI:1295856045
Name:PLUMB, BRYAN C (LICSW, LADC)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:C
Last Name:PLUMB
Suffix:
Gender:M
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BRENDA LN
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-2533
Mailing Address - Country:US
Mailing Address - Phone:603-424-1668
Mailing Address - Fax:
Practice Address - Street 1:650 SUFFOLK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3642
Practice Address - Country:US
Practice Address - Phone:978-452-5155
Practice Address - Fax:978-970-0713
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH543101YA0400X
MA1102691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical