1215286455 NPI number — MR. BRYAN JAMES HARNSBERGER PSY.D

Table of content: MR. BRYAN JAMES HARNSBERGER PSY.D (NPI 1215286455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215286455 NPI number — MR. BRYAN JAMES HARNSBERGER PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARNSBERGER
Provider First Name:
BRYAN
Provider Middle Name:
JAMES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215286455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 MICA LANE
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
WELLESLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-447-3178
Provider Business Mailing Address Fax Number:
617-325-0353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 MICA LANE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
WELLESLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-447-3178
Provider Business Practice Location Address Fax Number:
617-325-0353
Provider Enumeration Date:
09/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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