MEDICARE: DR. BRYSON BRESNAHAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	103TC2200X	Clinical Child & Adolescent Psychologist
3	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1043561202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYSON BRESNAHAN PH.D.

Provider Business Mailing Address
First Line	:	1150 THORN RUN RD
Second Line	:	SUITE 110
City	:	MOON TWP
State	:	PA
Zip	:	15108-3102
Country	:	US
Telephone Number	:	412-329-7778
Fax Number	:	412-262-1555

Provider Business Practice Location Address
First Line	:	1150 THORN RUN RD
Second Line	:	SUITE 110
City	:	MOON TWP
State	:	PA
Zip	:	15108-3102
Country	:	US
Telephone Number	:	412-329-7778
Fax Number	:	412-262-1555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	09/27/2012

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