Healthcare Provider Details

I. General information

NPI: 1922581743
Provider Name (Legal Business Name): PATRICIA EWART BRYANT MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ARMISTICE BLVD
PAWTUCKET RI
02860-3242
US

IV. Provider business mailing address

15 ACRE AVE
BARRINGTON RI
02806-2701
US

V. Phone/Fax

Practice location:
  • Phone: 401-722-3313
  • Fax:
Mailing address:
  • Phone: 401-289-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01874
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119872
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: