Bronson Destadler LICSW

NPI 1073514196 - Social Worker - 1041C0700X

NPI Details
NPI 1073514196
Gender Male
Enumeration Date 08/10/2005
Last Updated 07/08/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
143 STATE ST
NEWBURYPORT MA, 01950-6621, US
Phone (978) 462-2890
Fax (978) 462-2890
Business Location
143 STATE ST
NEWBURYPORT MA, 01950-6621, US
Phone (978) 462-2890
Fax (978) 462-2890
Toxanomy
Taxonomy Code 1041C0700X
License State Massachusetts
License Number 106400
Remove 1073514196 NPI Number
 

According to our database, Bronson Destadler LICSW NPI is 1073514196, taxonomy code is 1041C0700X and license number is 106400, license state is located at Massachusetts. Bronson Destadler LICSW physically located at 143 State St, Newburyport MA, 01950-6621. NPI Number Bronson Destadler LICSW has the Individual type.

Sponsored links

1073514196 NPI number is provided on an as is basis without warranty of any kind. 1073514196 is maintained by the National Plan & Provider Enumeration System. The contents of Bronson Destadler LICSW are for informational purposes only.