Individual
JIMMY BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CLINICALPSYCHOLOGIST
Contact information
Practice address
1213 VINE ST STE 121, PHILADELPHIA, PA 19107-1111
(215) 617-6510
(866) 854-7888
Mailing address
1213 VINE ST STE 121, PHILADELPHIA, PA 19107-1111
(215) 617-6510
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
455324367
PA
Other
Enumeration date
03/25/2013
Last updated
03/25/2013
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