Provider Demographics
NPI:1184958282
Name:BRYAN, REGINA (LMSW)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TILLARY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3026
Mailing Address - Country:US
Mailing Address - Phone:718-855-7485
Mailing Address - Fax:718-855-1316
Practice Address - Street 1:200 TILLARY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3026
Practice Address - Country:US
Practice Address - Phone:718-855-7485
Practice Address - Fax:718-855-1316
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0803171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical