Provider Demographics
NPI:1730251968
Name:BRYSON-BROCKMANN, WILLIAM A (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:BRYSON-BROCKMANN
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 1:222 STATION PLZ N
Mailing Address - Street 2:SUITE 611
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3808
Mailing Address - Country:US
Mailing Address - Phone:516-663-4432
Mailing Address - Fax:516-663-4409
Practice Address - Street 1:222 STATION PLZ N
Practice Address - Street 2:SUITE 611
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3808
Practice Address - Country:US
Practice Address - Phone:516-663-4432
Practice Address - Fax:516-663-4409
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009669103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0049693OtherGHI PPO
NY118426OtherVYTRA HEALTH PLAN
NYVA2061OtherEMPIRE BLUECROSS BLUESHIE
NYAS1545OtherOXFORD HEALTH PLANS