Provider Demographics
NPI:1588026868
Name:BRYANT, NATASHA
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 WALTON AVE
Mailing Address - Street 2:APT 25
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8952
Mailing Address - Country:US
Mailing Address - Phone:347-908-6051
Mailing Address - Fax:
Practice Address - Street 1:1097 WALTON AVE
Practice Address - Street 2:APT 25
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8952
Practice Address - Country:US
Practice Address - Phone:347-908-6051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst