Provider Demographics
NPI:1316458920
Name:BRYSON, REBEKAH MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:MARIE
Last Name:BRYSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36901 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4057
Mailing Address - Country:US
Mailing Address - Phone:440-930-6250
Mailing Address - Fax:440-930-6282
Practice Address - Street 1:36901 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4057
Practice Address - Country:US
Practice Address - Phone:440-930-6250
Practice Address - Fax:440-930-6282
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17002411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical