Provider Demographics
NPI:1922312784
Name:SHULTZ, BRYAN G (LCSW)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:G
Last Name:SHULTZ
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 1:7 SUMMER ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3076
Mailing Address - Country:US
Mailing Address - Phone:978-256-1444
Mailing Address - Fax:978-441-1773
Practice Address - Street 1:7 SUMMER ST
Practice Address - Street 2:SUITE 19
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3076
Practice Address - Country:US
Practice Address - Phone:978-256-1444
Practice Address - Fax:978-441-1773
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2054361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical