Provider Demographics
NPI:1295107845
Name:MCMANN, BRYANNE EVELYN (LICSW)
Entity type:Individual
Prefix:
First Name:BRYANNE
Middle Name:EVELYN
Last Name:MCMANN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PICKENS ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1903
Mailing Address - Country:US
Mailing Address - Phone:774-263-1655
Mailing Address - Fax:
Practice Address - Street 1:45 PICKENS ST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1903
Practice Address - Country:US
Practice Address - Phone:774-263-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1208181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical