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General NPI Number Information
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NPI Number | 1457460016
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Entity Type | Individual
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Provider Name | JOHNNIE ALFONSO BRYANT LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 1913 ATLANTIC AVE
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City | MANASQUAN
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State | NJ
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Zip | 08736-1029
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Country | US
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Telephone | 908-433-8083
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Fax |
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Provider Business Mailing Address
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Address Line | 937 CHELSEA DR
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City | BRICK
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State | NJ
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Zip | 08724-1074
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Country | US
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Telephone | 908-433-8083
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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 | 44SC05249000
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License Number State | NJ
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