Provider Demographics
NPI:1346347135
Name:BRYAN, SHEILA A (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:A
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HAMPSHIRE ST
Mailing Address - Street 2:UNIT 4A
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-6400
Mailing Address - Country:US
Mailing Address - Phone:603-785-2948
Mailing Address - Fax:603-218-6295
Practice Address - Street 1:5 HAMPSHIRE ST
Practice Address - Street 2:UNIT 4A
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-6400
Practice Address - Country:US
Practice Address - Phone:603-785-2948
Practice Address - Fax:603-218-6295
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15151041C0700X, 1041C0700X
FLSW95751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q27076Medicare UPIN
SCQ33999Medicare ID - Type Unspecified