Provider Demographics
NPI:1942504105
Name:BRYANT, ANGELA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:M
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 1:8659 BROOKSHIRE LN
Mailing Address - Street 2:APT A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-4716
Mailing Address - Country:US
Mailing Address - Phone:314-995-7072
Mailing Address - Fax:
Practice Address - Street 1:4585 WASHINGTON ST
Practice Address - Street 2:SUITE A4
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5858
Practice Address - Country:US
Practice Address - Phone:314-837-0000
Practice Address - Fax:314-837-0002
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010039058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker