Provider Demographics
NPI:1689436925
Name:BRYAN, KARL III (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:BRYAN
Suffix:III
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-4703
Mailing Address - Country:US
Mailing Address - Phone:781-392-9422
Mailing Address - Fax:
Practice Address - Street 1:1715 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4703
Practice Address - Country:US
Practice Address - Phone:781-392-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker