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NPI Code Detail

MEDICARE: BENJAMIN MATTHEW BRYAN LCSW

MEDICARE: BENJAMIN MATTHEW 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
11041C0700XClinical Social WorkerL5304OR

General Provider Information

NPI Number : 1306912324
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN MATTHEW BRYAN LCSW
Provider Business Mailing Address
First Line : 1215 SW G ST
Second Line :
City : GRANTS PASS
State : OR
Zip : 97526-2544
Country : US
Telephone Number : 541-476-2373
Fax Number : 541-774-7979
Provider Business Practice Location Address
First Line : 200 BEATTY ST
Second Line :
City : MEDFORD
State : OR
Zip : 97501-5811
Country : US
Telephone Number : 541-476-2373
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 02/07/2024

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