Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TS0200X | School Psychologist |
NPI | 1043561202 |
---|---|
Provider Name | Dr. Bryson Bresnahan |
First Address | Moon Twp, PA 15108-3102 |
Second Address | Moon Twp, PA 15108-3102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2012 |
Last Update Date | 27/09/2012 |