Provider Demographics
NPI:1285954727
Name:BRYSON, JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:BRYSON
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:PO BOX 5413
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90409-5413
Mailing Address - Country:US
Mailing Address - Phone:310-570-2509
Mailing Address - Fax:800-313-7756
Practice Address - Street 1:3201 WILSHIRE BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2344
Practice Address - Country:US
Practice Address - Phone:310-570-2509
Practice Address - Fax:800-313-7756
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8748103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist