Provider Demographics
NPI:1386099356
Name:HARRISON, BRYAN ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ROBERT
Last Name:HARRISON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 PITTSFORD VICTOR RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3934
Mailing Address - Country:US
Mailing Address - Phone:585-210-9730
Mailing Address - Fax:585-495-2070
Practice Address - Street 1:610 PITTSFORD VICTOR RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534
Practice Address - Country:US
Practice Address - Phone:585-210-9730
Practice Address - Fax:585-495-2070
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical