Bronson Destadler, LICSW
NPI #1073514196 in Newburyport, Massachusetts
Provider Information
- NPI Number
- 1073514196
- Entity Type
- Individual
- Name
- Bronson Destadler, LICSW
- Gender
- Not Specified
- Sole Proprietor
- Not Answered
- Primary Specialty
- Social Worker - Clinical
- Credential
- LICSW
- Enumeration Date
- Aug 10, 2005
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 143 STATE ST
- City
- Newburyport
- State
- Massachusetts
- ZIP Code
- 01950-6621
- Phone
- (978) 462-2890
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker - Clinical — Clinical |
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