Provider Demographics
NPI:1639387855
Name:BRESCIA, JOHN J (MA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:BRESCIA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MARKET ST
Mailing Address - Street 2:SUITE 107B
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2616
Mailing Address - Country:US
Mailing Address - Phone:330-788-5769
Mailing Address - Fax:
Practice Address - Street 1:5500 MARKET ST
Practice Address - Street 2:SUITE 107B
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2601
Practice Address - Country:US
Practice Address - Phone:330-788-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2743103T00000X
PAPS002545-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist