MEDICARE: MR. PHILLIP STANLEY BRYSON M.S.W.

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	CSW09923044	CO
2	1041C0700X	Clinical Social Worker	SW10452	FL

General Provider Information

NPI Number	:	1326585324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILLIP STANLEY BRYSON M.S.W.

Provider Business Mailing Address
First Line	:	1169 N LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-3114
Country	:	US
Telephone Number	:	813-951-7058
Fax Number	:

Provider Business Practice Location Address
First Line	:	1169 N LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-3114
Country	:	US
Telephone Number	:	813-951-7058
Fax Number	:

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

Provider Enumeration Date	:	01/27/2017
Last Update Date	:	01/27/2017

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