Healthcare Provider Details

I. General information

NPI: 1063749356
Provider Name (Legal Business Name): BRYAN R HALL II MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 STORRS RD
MANSFIELD CENTER CT
06250-1683
US

IV. Provider business mailing address

189 STORRS RD
MANSFIELD CENTER CT
06250-1683
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-1311
  • Fax: 860-423-6114
Mailing address:
  • Phone: 860-456-1311
  • Fax: 860-423-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: