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General NPI Number Information
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NPI Number | 1003536343
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Entity Type | Individual
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Provider Name | BRENNAN PEDERSEN
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Gender | Male
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 31 WASHINGTON SQ W STE 6B
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City | NEW YORK
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State | NY
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Zip | 10011-9126
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Country | US
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Telephone | 206-890-7816
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Fax |
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Provider Business Mailing Address
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Address Line | 92 BUTLER ST APT 3R
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City | BROOKLYN
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State | NY
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Zip | 11231-4989
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Country | US
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Telephone | 206-890-7816
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number | 001153
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License Number State | NY
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