Healthcare Provider Details

I. General information

NPI: 1215286455
Provider Name (Legal Business Name): BRYAN JAMES HARNSBERGER PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 09/11/2025
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MICA LANE SUITE 205
WELLESLEY MA
02481
US

IV. Provider business mailing address

14 MICA LANE SUITE 205
WELLESLEY MA
02481
US

V. Phone/Fax

Practice location:
  • Phone: 401-447-3178
  • Fax: 617-325-0353
Mailing address:
  • Phone: 401-447-3178
  • Fax: 617-325-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: