MEDICARE: BRYN MARTINEZ ZAVRAS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1285104133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYN MARTINEZ ZAVRAS PHD

Provider Business Mailing Address
First Line	:	2245 GILBERT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-3040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 GILBERT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-3040
Country	:	US
Telephone Number	:	978-315-5889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2018
Last Update Date	:	06/16/2021

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