Provider Demographics
NPI:1154963957
Name:BRYANT, DANIELLE C (MS, MHC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:C
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 6TH AVE RM 1604
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3574
Mailing Address - Country:US
Mailing Address - Phone:865-384-2770
Mailing Address - Fax:
Practice Address - Street 1:875 6TH AVE RM 1604
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3574
Practice Address - Country:US
Practice Address - Phone:917-342-2351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103219-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health