Healthcare Provider Details

I. General information

NPI: 1497799381
Provider Name (Legal Business Name): HOLLIE D BRAYER M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 OLD YORK RD STE 525A
JENKINTOWN PA
19046-3721
US

IV. Provider business mailing address

242 IRONWOOD CIR
ELKINS PARK PA
19027-1315
US

V. Phone/Fax

Practice location:
  • Phone: 215-915-3000
  • Fax:
Mailing address:
  • Phone: 215-915-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS005000L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: