Healthcare Provider Details

I. General information

NPI: 1609339126
Provider Name (Legal Business Name): BRYAN I. PROANO REDMOND LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 SPRINGFIELD AVE
SUMMIT NJ
07901-2601
US

IV. Provider business mailing address

440 ELMWOOD AVE
MAPLEWOOD NJ
07040-1715
US

V. Phone/Fax

Practice location:
  • Phone: 908-273-5558
  • Fax:
Mailing address:
  • Phone: 347-944-7436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06118700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: