Provider Demographics
NPI:1407333750
Name:BRYNER, ALEXA KAY (LSW)
Entity Type:Individual
Prefix:MISS
First Name:ALEXA
Middle Name:KAY
Last Name:BRYNER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SUNSHINE CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-9275
Mailing Address - Country:US
Mailing Address - Phone:570-809-6479
Mailing Address - Fax:
Practice Address - Street 1:8638 ROUTE 104 STE 10
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT MILLS
Practice Address - State:PA
Practice Address - Zip Code:17853-8753
Practice Address - Country:US
Practice Address - Phone:717-856-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135336104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker