Provider Demographics
NPI:1306671987
Name:ABBOTT, BRYAN (MS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764-0166
Mailing Address - Country:US
Mailing Address - Phone:774-222-1879
Mailing Address - Fax:
Practice Address - Street 1:30 TAUNTON GRN STE 5
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3243
Practice Address - Country:US
Practice Address - Phone:508-545-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health