Provider Demographics
NPI:1619379252
Name:TENNYSON, BRITTANY LEIGH (EDS)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:LEIGH
Last Name:TENNYSON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-1728
Mailing Address - Country:US
Mailing Address - Phone:724-470-7419
Mailing Address - Fax:
Practice Address - Street 1:2112 CASE PKWY STE 10
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2378
Practice Address - Country:US
Practice Address - Phone:724-499-5183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH600103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool