Provider Demographics
NPI:1316485584
Name:MCASKILL, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:MCASKILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ELM ST
Mailing Address - Street 2:APT 3
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-2440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 ELM ST
Practice Address - Street 2:APT 3
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-2440
Practice Address - Country:US
Practice Address - Phone:978-728-8017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACDW981977120OtherBLUE CROSS BLUE SHIELD