Healthcare Provider Details

I. General information

NPI: 1366068298
Provider Name (Legal Business Name): MICHAEL ANDREW BRYANT MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16126 MAGNOLIA HILL ST
CLERMONT FL
34714-4907
US

IV. Provider business mailing address

16126 MAGNOLIA HILL ST
CLERMONT FL
34714-4907
US

V. Phone/Fax

Practice location:
  • Phone: 407-577-8571
  • Fax:
Mailing address:
  • Phone: 407-577-8571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW19990
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: