Provider Demographics
NPI:1831102326
Name:BRONSON, MARY KRISTINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KRISTINE
Last Name:BRONSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 SILVERSIDE ROAD
Mailing Address - Street 2:WELDIN BUILDING, SUITE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810
Mailing Address - Country:US
Mailing Address - Phone:302-477-0708
Mailing Address - Fax:302-477-0136
Practice Address - Street 1:3411 SILVERSIDE ROAD
Practice Address - Street 2:WELDIN BUILDING, SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810
Practice Address - Country:US
Practice Address - Phone:302-477-0708
Practice Address - Fax:302-477-0136
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007909L103T00000X
DEB10000424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE20-5394326OtherPSYCHOLOGIST
DE851513Medicare ID - Type UnspecifiedPSYCHOLOGIST