Provider Demographics
NPI:1790024347
Name:BRYANT, HEATHER J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:J
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 1:2399 ATLANTIC HWY
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04849-5322
Mailing Address - Country:US
Mailing Address - Phone:207-236-4851
Mailing Address - Fax:
Practice Address - Street 1:116 TILLSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3424
Practice Address - Country:US
Practice Address - Phone:207-930-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC152341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical