Provider Demographics
NPI:1093783607
Name:BRENTZEL, PHYLLIS REAMS (PSY D)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:REAMS
Last Name:BRENTZEL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 PINE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-9529
Mailing Address - Country:US
Mailing Address - Phone:724-863-6488
Mailing Address - Fax:724-863-6488
Practice Address - Street 1:12320 ROUTE 30
Practice Address - Street 2:SUITES 4 & 6
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-1872
Practice Address - Country:US
Practice Address - Phone:724-863-6488
Practice Address - Fax:724-863-6488
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008841L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01778104Medicaid
PA151034OtherVAUEOPTIONS
PA349177OtherMAGELLAN
PA349177OtherMAGELLAN