Provider Demographics
NPI:1306466792
Name:BRYANT-BOSSHOLD, DEVIN ERICH (LMHC)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:ERICH
Last Name:BRYANT-BOSSHOLD
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 IFFLEY RD APT 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2307
Mailing Address - Country:US
Mailing Address - Phone:413-652-7861
Mailing Address - Fax:
Practice Address - Street 1:18 IFFLEY RD APT 1
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2307
Practice Address - Country:US
Practice Address - Phone:413-652-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health