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NPI Code Detail

MEDICARE: AMY E. BRYAN LCSW, RPT

MEDICARE: AMY E. BRYAN LCSW, RPT
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 Worker35688TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10015LJOTHERTXBLUE CROSS BLUE SHEILD

General Provider Information

NPI Number : 1750404653
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY E. BRYAN LCSW, RPT
Provider Business Mailing Address
First Line : 601 W 18TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78701-1111
Country : US
Telephone Number : 512-589-4849
Fax Number :
Provider Business Practice Location Address
First Line : 601 W 18TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78701-1111
Country : US
Telephone Number : 512-589-4849
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2007
Last Update Date : 07/08/2007

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Directions to “ AMY E. BRYAN LCSW, RPT” Practice Location

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