Provider Demographics
NPI:1386313815
Name:CHICO, BRYAN HOWARD (ASW, MSW)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:HOWARD
Last Name:CHICO
Suffix:
Gender:M
Credentials:ASW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44443 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3346
Mailing Address - Country:US
Mailing Address - Phone:661-726-2630
Mailing Address - Fax:661-940-3412
Practice Address - Street 1:44443 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3346
Practice Address - Country:US
Practice Address - Phone:661-726-2630
Practice Address - Fax:661-940-3412
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 390200000X
CA1090691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program