Provider Demographics
NPI:1043569197
Name:MEYER, BRIAN S (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:MEYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEAUMONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2507
Mailing Address - Country:US
Mailing Address - Phone:516-650-0595
Mailing Address - Fax:516-938-3833
Practice Address - Street 1:35 BEAUMONT DRIVE
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2507
Practice Address - Country:US
Practice Address - Phone:516-650-0595
Practice Address - Fax:516-938-3833
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012010103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical