Provider Demographics
NPI:1801448501
Name:BRYANT, ANTONIA C (LMSW/CSW-I)
Entity type:Individual
Prefix:MRS
First Name:ANTONIA
Middle Name:C
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LMSW/CSW-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 E DEER SPRINGS WAY APT 2061
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1464
Mailing Address - Country:US
Mailing Address - Phone:323-599-6740
Mailing Address - Fax:
Practice Address - Street 1:4485 S BUFFALO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-5006
Practice Address - Country:US
Practice Address - Phone:702-888-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9923-M104100000X
NVIC-23391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical