Provider Demographics
NPI:1477064962
Name:NORMAN, BRYAN D (LCSW)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:D
Last Name:NORMAN
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 1:6032 REDONDO SIERRA VIS NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-0606
Mailing Address - Country:US
Mailing Address - Phone:703-945-4535
Mailing Address - Fax:
Practice Address - Street 1:6032 REDONDO SIERRA VIS NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-0606
Practice Address - Country:US
Practice Address - Phone:703-945-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-086611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty