Provider Demographics
NPI:1609339126
Name:PROANO, BRYAN I (LCSW)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:I
Last Name:PROANO
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 1:107 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2220
Mailing Address - Country:US
Mailing Address - Phone:347-944-7436
Mailing Address - Fax:
Practice Address - Street 1:460 W 41ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6801
Practice Address - Country:US
Practice Address - Phone:212-613-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC061187001041C0700X
NY1027011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical