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Individual

BRYAN JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
50 W HAWTHORNE AVE, VALLEY STREAM, NY 11580-6220
(516) 569-6600
Mailing address
2150 DECKER AVE, MERRICK, NY 11566-2127
(516) 712-8962

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
104857
NY

Other

Enumeration date
10/02/2018
Last updated
10/02/2018
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