Provider Demographics
NPI:1790939692
Name:BARRY, BRYAN TIMOTHY (MSW LCSW)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:TIMOTHY
Last Name:BARRY
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VETERANS POINTE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1570
Mailing Address - Country:US
Mailing Address - Phone:314-374-0479
Mailing Address - Fax:
Practice Address - Street 1:10 VETERANS POINTE LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1570
Practice Address - Country:US
Practice Address - Phone:314-374-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC165131041C0700X
MO20050259821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical