Basic Information
| Provider Information | |||||||||
| NPI: | 1073673943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYANT | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LICSW, CADAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 286 ESSEX ST | ||||||||
| Address2: | |||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010403209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135360017 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 367 PINE ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011051930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137371426 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 02/01/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1272AD | MA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 212348 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.