Provider Demographics
NPI:1326207820
Name:BRYAN, GERALDNE F (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GERALDNE
Middle Name:F
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-6005
Mailing Address - Country:US
Mailing Address - Phone:574-291-1762
Mailing Address - Fax:
Practice Address - Street 1:1443 HAMPSHIRE DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-6005
Practice Address - Country:US
Practice Address - Phone:574-291-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health