Provider Demographics
NPI:1962900258
Name:ESPOSITO, BRIAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:ESPOSITO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BETHANY RD APT E
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2400
Mailing Address - Country:US
Mailing Address - Phone:908-878-7216
Mailing Address - Fax:
Practice Address - Street 1:1834 OREGON PIKE STE 4
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6463
Practice Address - Country:US
Practice Address - Phone:717-391-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical