Provider Demographics
NPI:1881665198
Name:COLE, BRENDA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:S
Last Name:COLE
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 1:90 W CHESTNUT ST
Mailing Address - Street 2:SUITE 609
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4524
Mailing Address - Country:US
Mailing Address - Phone:412-913-3815
Mailing Address - Fax:724-222-1189
Practice Address - Street 1:90 W CHESTNUT ST
Practice Address - Street 2:SUITE 609
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4524
Practice Address - Country:US
Practice Address - Phone:412-913-3815
Practice Address - Fax:724-222-1189
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015173103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001941894Medicaid
PAP80688Medicare UPIN
PA067165Medicare PIN