Healthcare Provider Details

I. General information

NPI: 1992216790
Provider Name (Legal Business Name): BRISMAN ASSOCIATES IN NEUROPSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 S MAIN ST STE 225
WEST HARTFORD CT
06110-2812
US

IV. Provider business mailing address

PO BOX 370113
WEST HARTFORD CT
06137-0113
US

V. Phone/Fax

Practice location:
  • Phone: 860-707-2775
  • Fax: 860-707-2775
Mailing address:
  • Phone: 860-707-2775
  • Fax: 860-540-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number002344
License Number StateCT

VIII. Authorized Official

Name: DR. MICHELLE ANN BRISMAN
Title or Position: NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 860-707-2775