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General NPI Number Information
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NPI Number | 1003342338
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Entity Type | Individual
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Provider Name | BRYAN T ASTON JR. LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 5300 NW 55TH BLVD APT 308
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3785
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Country | US
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Telephone | 917-485-9664
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Fax |
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Provider Business Mailing Address
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Address Line | 5300 NW 55TH BLVD APT 308
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3785
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Country | US
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Telephone | 917-485-9664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089566
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License Number State | NY
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