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General NPI Number Information
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NPI Number | 1710764329
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Entity Type | Organization
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Legal Business Name | UPSHUR BREN PSYCHOLOGY GROUP
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 629 FIFTH AVE STE 109
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City | PELHAM
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State | NY
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Zip | 10803-3708
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Country | US
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Telephone | 914-368-2995
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Fax |
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Provider Business Mailing Address
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Address Line | 629 FIFTH AVE STE 109
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City | PELHAM
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State | NY
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Zip | 10803-3708
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INTAKE COORDINATOR/EXECUTIVE ASST.
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Name | ERIN SCHALLMOSER
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Credential |
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Telephone | 813-428-2122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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