Provider Demographics
NPI:1891910667
Name:BRONSTEIN, CHERYL BRYCE (LCSW, BCD)
Entity type:Individual
Prefix:MS
First Name:CHERYL BRYCE
Middle Name:
Last Name:BRONSTEIN
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:142 JORALEMON ST
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4709
Mailing Address - Country:US
Mailing Address - Phone:718-488-0748
Mailing Address - Fax:810-815-6729
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:SUITE 10A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4709
Practice Address - Country:US
Practice Address - Phone:718-488-0748
Practice Address - Fax:810-815-6729
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO22315-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11235523OtherCAQH
NYP690122OtherOXFORD HEALTH PLANS
NYRO22315-1OtherLICENSED CLINICAL SOCIAL
NYRO22315-1OtherLICENSED CLINICAL SOCIAL