Provider Demographics
NPI:1336826023
Name:CENICOLA, BRYNN (MA)
Entity Type:Individual
Prefix:
First Name:BRYNN
Middle Name:
Last Name:CENICOLA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BRYNN
Other - Middle Name:
Other - Last Name:CENICOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CELLAN: MA
Mailing Address - Street 1:8721 172ND ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2272
Mailing Address - Country:US
Mailing Address - Phone:615-318-4986
Mailing Address - Fax:
Practice Address - Street 1:4113 BRIDGEPORT WAY W STE C
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4325
Practice Address - Country:US
Practice Address - Phone:615-318-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61240730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health