Provider Demographics
NPI:1205541562
Name:EBERENZ, BRENDAN JAMES (PSYD, ABPP)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:JAMES
Last Name:EBERENZ
Suffix:
Gender:M
Credentials:PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 BOWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15478-1019
Mailing Address - Country:US
Mailing Address - Phone:614-623-0392
Mailing Address - Fax:
Practice Address - Street 1:446 GREENBAG RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-7159
Practice Address - Country:US
Practice Address - Phone:304-284-5371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical