Provider Demographics
NPI:1508066556
Name:BRYANT, KARA (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PURKIS RD
Mailing Address - Street 2:
Mailing Address - City:BUCKFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04220-4003
Mailing Address - Country:US
Mailing Address - Phone:207-570-7193
Mailing Address - Fax:
Practice Address - Street 1:40 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6446
Practice Address - Country:US
Practice Address - Phone:207-945-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC111131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical