Provider Demographics
NPI:1366147563
Name:BRYAN, AMBER MARIE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 MAEGAN PL APT 1
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2763
Mailing Address - Country:US
Mailing Address - Phone:818-232-2557
Mailing Address - Fax:
Practice Address - Street 1:5250 RALSTON ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7318
Practice Address - Country:US
Practice Address - Phone:310-714-2557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0009925102OtherLICENSED SOCIAL WORKER
CT9134OtherLICENSED MASTER SOCIAL WORKER
CAASW118914OtherASSOCIATE CLINICAL SOCIAL WORKER