Healthcare Provider Details

I. General information

NPI: 1174189955
Provider Name (Legal Business Name): DOLORES BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MISSISSIPPI AVE SE APT 121
WASHINGTON DC
20032-4448
US

IV. Provider business mailing address

1818 NEW YORK AVE NE STE 115
WASHINGTON DC
20002-1851
US

V. Phone/Fax

Practice location:
  • Phone: 202-621-4419
  • Fax:
Mailing address:
  • Phone: 301-799-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG200004622
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: