Provider Demographics
NPI:1023455292
Name:SAMS, BRYAN (MSW, RCSWI)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:SAMS
Suffix:
Gender:M
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1392
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34673-1392
Mailing Address - Country:US
Mailing Address - Phone:727-481-1961
Mailing Address - Fax:
Practice Address - Street 1:3825 HENDERSON BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5037
Practice Address - Country:US
Practice Address - Phone:813-409-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW-76571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical