Provider Demographics
NPI:1538612536
Name:BRYCE, ANTOINETTE
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:BRYCE
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 1:3035 RADCLIFF AVE
Mailing Address - Street 2:APT 4C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3922
Mailing Address - Country:US
Mailing Address - Phone:917-832-5478
Mailing Address - Fax:
Practice Address - Street 1:3035 RADCLIFF AVE
Practice Address - Street 2:APT 4C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3922
Practice Address - Country:US
Practice Address - Phone:917-832-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0904181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical