Provider Demographics
NPI:1568919132
Name:SAFRANSKI, BRYAN (MA LLP)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:SAFRANSKI
Suffix:
Gender:M
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-0177
Mailing Address - Country:US
Mailing Address - Phone:269-655-3345
Mailing Address - Fax:269-427-1012
Practice Address - Street 1:34276 52ND STREET
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-0177
Practice Address - Country:US
Practice Address - Phone:269-655-3345
Practice Address - Fax:269-427-1012
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009926103T00000X
MI6361002723103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist