Provider Demographics
NPI:1992216790
Name:BRISMAN ASSOCIATES IN NEUROPSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:BRISMAN ASSOCIATES IN NEUROPSYCHOLOGY, PLLC
Other - Org Name:BRAIN SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-707-2775
Mailing Address - Street 1:PO BOX 370113
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06137-0113
Mailing Address - Country:US
Mailing Address - Phone:860-707-2775
Mailing Address - Fax:860-540-1114
Practice Address - Street 1:433 S MAIN ST STE 225
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2812
Practice Address - Country:US
Practice Address - Phone:860-707-2775
Practice Address - Fax:860-707-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002344103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty