Provider Demographics
NPI:1023162203
Name:BRYANT, ROBIN A (PHD IN CLINICAL PSYC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:A
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PHD IN CLINICAL PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W 88TH STREET
Mailing Address - Street 2:APT 3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-721-8910
Mailing Address - Fax:212-721-8910
Practice Address - Street 1:134 W 88TH STREET
Practice Address - Street 2:APT 3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-721-8910
Practice Address - Fax:212-721-8910
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV4C951Medicare ID - Type Unspecified