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General NPI Number Information
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NPI Number | 1255615142
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Entity Type | Individual
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Provider Name | SAMANTHA K BRYANT LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 1601 HOOKS ST
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City | CLERMONT
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State | FL
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Zip | 34711-3510
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Country | US
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Telephone | 407-953-8968
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Fax |
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Provider Business Mailing Address
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Address Line | 1726 GARDEN VIEW ST
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City | MASCOTTE
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State | FL
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Zip | 34753-9541
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Country | US
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Telephone | 407-953-8968
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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 | ISW6902
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW12620
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License Number State | FL
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