Provider Demographics
NPI:1902163371
Name:BRASCO, GREGORY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:BRASCO
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 1:1229 DELAWARE LN
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3838
Mailing Address - Country:US
Mailing Address - Phone:610-453-5117
Mailing Address - Fax:
Practice Address - Street 1:1229 DELAWARE LN
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3838
Practice Address - Country:US
Practice Address - Phone:610-453-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA172Y1681103TC0700X
PA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool