Provider Demographics
NPI:1417722208
Name:STINSON, BRENDAN
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:
Last Name:STINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W METZGER AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-3384
Mailing Address - Country:US
Mailing Address - Phone:724-679-2704
Mailing Address - Fax:
Practice Address - Street 1:106 W METZGER AVE
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-3384
Practice Address - Country:US
Practice Address - Phone:724-679-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA18687101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)