Provider Demographics
NPI:1609246420
Name:BRYANT, KINGSLEY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KINGSLEY
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 HARMONYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520-8975
Mailing Address - Country:US
Mailing Address - Phone:484-868-2026
Mailing Address - Fax:
Practice Address - Street 1:29 W LANCASTER AVE STE 303
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1408
Practice Address - Country:US
Practice Address - Phone:484-868-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0162511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical