Provider Demographics
NPI:1063705176
Name:BRISLIN, EMILY ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ELIZABETH
Last Name:BRISLIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAYFAIR LN
Mailing Address - Street 2:
Mailing Address - City:BYRAM TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-3534
Mailing Address - Country:US
Mailing Address - Phone:973-975-3641
Mailing Address - Fax:973-426-3108
Practice Address - Street 1:350 SPARTA AVE
Practice Address - Street 2:STE C8
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1120
Practice Address - Country:US
Practice Address - Phone:908-979-1144
Practice Address - Fax:908-979-1068
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016926103T00000X
NJ35S100496600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist