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General NPI Number Information
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NPI Number | 1881779924
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Entity Type | Individual
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Provider Name | BRYAN MICHAEL FALLON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 85 5TH AVE SUITE 908
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City | NEW YORK
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State | NY
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Zip | 10003-3019
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Country | US
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Telephone | 212-886-4874
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Fax | 212-410-6318
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Provider Business Mailing Address
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Address Line | 296 RUGBY RD
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City | BROOKLYN
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State | NY
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Zip | 11226-4552
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Country | US
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Telephone | 212-886-4874
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 012513
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License Number State | NY
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