Healthcare Provider Details

I. General information

NPI: 1609895440
Provider Name (Legal Business Name): WILLIAM ALLEN BREZINSKI M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 HUNTER PARK LAUREL RIDGE PSYCHOLOGICAL ASSOCIATES
PRINCETON WV
24740
US

IV. Provider business mailing address

211 HUNTER PARK LAUREL RIDGE PSYCHOLOGICAL ASSOCIATES
PRINCETON WV
24740
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-6121
  • Fax: 304-487-8741
Mailing address:
  • Phone: 304-487-6121
  • Fax: 304-487-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number282
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number22034
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: