Provider Demographics
NPI:1457460016
Name:BRYANT, JOHNNIE ALFONSO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:ALFONSO
Last Name:BRYANT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1074
Mailing Address - Country:US
Mailing Address - Phone:908-433-8083
Mailing Address - Fax:
Practice Address - Street 1:1913 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1029
Practice Address - Country:US
Practice Address - Phone:908-433-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052490001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical