MEDICARE: SARA BRYAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	09929232	CO

General Provider Information

NPI Number	:	1679236640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA BRYAN LCSW

Provider Business Mailing Address
First Line	:	4851 INDEPENDENCE ST FL 1
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-6715
Country	:	US
Telephone Number	:	303-425-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 W 8TH AVE STE 200
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-5553
Country	:	US
Telephone Number	:	303-271-6100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	08/15/2023

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Directions to “ SARA BRYAN LCSW” Practice Location

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