BRONSON DESTADLER, LICSW
Social Worker - Clinical
Active
Individual
NPI: 1073514196
Specialties
| Specialty | Code | Primary | License |
|---|---|---|---|
| Social Worker - Clinical | 1041C0700X | Yes | 106400 (MA) |
Frequently Asked Questions
NPI 1073514196 is the National Provider Identifier for BRONSON DESTADLER, LICSW, a Social Worker - Clinical provider located in Newburyport, MA. This NPI was enumerated on August 10, 2005.
BRONSON DESTADLER, LICSW practices at 143 STATE ST, Newburyport, MA 01950.
Quick Facts
- NPI
- 1073514196
- Type
- Individual
- Enumerated
- Aug 10, 2005
- Last Updated
- Jul 8, 2007
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