Delora V Putnam-Bryant, ATR-BC

Primary specialty

Art TherapistTaxonomy code 221700000X

License

14-304 Issued in WI

Practice address

7646 N Teutonia Ave
Brown Deer, WI 53209-1736

Phone

(414) 797-2155

Fax

(414) 797-2156

NPI assigned

May 11, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Art Therapy House, Inc.

  • Community/Behavioral Health Agency
  • Brown Deer, WI
  • NPI 1770036923
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620691200000",
    "number": "1386228641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 N 16TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532096922",
            "telephone_number": "414-262-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7646 N TEUTONIA AVE",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091736",
            "telephone_number": "414-797-2155",
            "fax_number": "414-797-2156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTNAM-BRYANT",
        "first_name": "DELORA",
        "middle_name": "V",
        "name_prefix": "Mrs.",
        "credential": "ATR-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-11",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": "WI",
            "license": "14-304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ART THERAPY HOUSE, INC",
            "identifier": "14-3062691",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Cheryl Lynn Ray, MS

• Art Therapist in Brown Deer, WI
• Providers in Brown Deer, WI by specialty
• Art Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.