Provider Demographics
NPI:1356596282
Name:WADE, BRYAN PATRICK (LMHC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:PATRICK
Last Name:WADE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119-1647
Mailing Address - Country:US
Mailing Address - Phone:413-426-0564
Mailing Address - Fax:413-363-9546
Practice Address - Street 1:45 HOPE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119-1647
Practice Address - Country:US
Practice Address - Phone:413-426-0564
Practice Address - Fax:413-363-9546
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6625101YM0800X
CT001701101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional