Provider Demographics
NPI:1912130980
Name:BRELSFORD, GINA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:BRELSFORD
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 1:56 ERFORD RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2304
Mailing Address - Country:US
Mailing Address - Phone:717-901-9280
Mailing Address - Fax:717-909-1288
Practice Address - Street 1:56 ERFORD RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2304
Practice Address - Country:US
Practice Address - Phone:717-901-9280
Practice Address - Fax:717-909-1288
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical