Healthcare Provider Details

I. General information

NPI: 1902527427
Provider Name (Legal Business Name): CLARISSA BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/05/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BANKS AVE
MCADOO PA
18237-2508
US

IV. Provider business mailing address

560 VAN REED RD
WYOMISSING PA
19610-1799
US

V. Phone/Fax

Practice location:
  • Phone: 888-726-4774
  • Fax: 570-362-5112
Mailing address:
  • Phone: 888-726-4776
  • Fax: 570-362-5112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: