1649714270 NPI number — PAULETTE E BRYAN LCSW

Table of content: PAULETTE E BRYAN LCSW (NPI 1649714270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649714270 NPI number — PAULETTE E BRYAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYAN
Provider First Name:
PAULETTE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649714270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22401-5719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-373-3223
Provider Business Mailing Address Fax Number:
540-371-3753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7424 BROCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOTSYLVANIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22553-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-582-3980
Provider Business Practice Location Address Fax Number:
540-371-3753
Provider Enumeration Date:
12/16/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904009526 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)