MEDICARE: GRACE S BRYAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW.09932485	CO
2	1041C0700X	Clinical Social Worker	0904019513	VA

General Provider Information

NPI Number	:	1164140414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE S BRYAN LCSW

Provider Business Mailing Address
First Line	:	3226 N RALEIGH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-1708
Country	:	US
Telephone Number	:	301-338-1936
Fax Number	:	303-943-1890

Provider Business Practice Location Address
First Line	:	3226 N RALEIGH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-1708
Country	:	US
Telephone Number	:	301-338-1936
Fax Number	:	303-943-1890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	12/09/2025

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Directions to “ GRACE S BRYAN LCSW” Practice Location

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