Provider Demographics
NPI:1649423591
Name:BRYANT, ANTHONY (CASAC, ICDAC, SAP)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BRYANT
Suffix:
Gender:M
Credentials:CASAC, ICDAC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1411
Mailing Address - Country:US
Mailing Address - Phone:718-536-4913
Mailing Address - Fax:718-228-8514
Practice Address - Street 1:1369 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7200
Practice Address - Country:US
Practice Address - Phone:718-536-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17125101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)