Healthcare Provider Details

I. General information

NPI: 1922466234
Provider Name (Legal Business Name): SCHERELL D.G. BRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 RUSS ST
HARTFORD CT
06106-5408
US

IV. Provider business mailing address

67 RUSS ST
HARTFORD CT
06106-5408
US

V. Phone/Fax

Practice location:
  • Phone: 225-715-0608
  • Fax:
Mailing address:
  • Phone: 225-715-0608
  • Fax: 225-406-7671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5559
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number011058
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10126
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number46.003855
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: