Provider Demographics
NPI:1538376991
Name:MAGUIRE, BRENT LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:LEE
Last Name:MAGUIRE
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 1:2536 EASTERN BLVD
Mailing Address - Street 2:#186
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2914
Mailing Address - Country:US
Mailing Address - Phone:717-817-5809
Mailing Address - Fax:
Practice Address - Street 1:2536 EASTERN BLVD
Practice Address - Street 2:#186
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2914
Practice Address - Country:US
Practice Address - Phone:717-817-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005159-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist