Provider Demographics
NPI:1255079042
Name:BRYAN, CATHERINE MARIE (DNP, MSN, PMHCNS-BC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:DNP, MSN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 YOUNGS FORD RD
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-1621
Mailing Address - Country:US
Mailing Address - Phone:703-851-3883
Mailing Address - Fax:
Practice Address - Street 1:935 YOUNGS FORD RD
Practice Address - Street 2:
Practice Address - City:GLADWYNE
Practice Address - State:PA
Practice Address - Zip Code:19035-1621
Practice Address - Country:US
Practice Address - Phone:703-851-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0147130364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, GeropsychiatricGroup - Single Specialty