Individual provider · Type 1 NPI

Bronson Destadler, LICSW

Clinical Social Worker · Newburyport, MA

NPI number 1073514196 Active

Practice location

143 State St
Newburyport, MA 01950-6621

Call (978) 462-2890 Map

Fax (978) 462-2890

Specialties and licenses

TaxonomyCodeLicense
Clinical Social Worker Primary 1041C0700X106400 (MA)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1073514196

Bronson Destadler, LICSW's National Provider Identifier is 1073514196, issued on Aug 10, 2005. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Newburyport, MA. The record was last updated on Jul 13, 2026.