Provider Demographics
NPI:1366780553
Name:KERRIANNE BRESNAN, PSY.D., LLC
Entity type:Organization
Organization Name:KERRIANNE BRESNAN, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-321-1980
Mailing Address - Street 1:3471 N FEDERAL HWY STE 508
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1052
Mailing Address - Country:US
Mailing Address - Phone:954-321-1980
Mailing Address - Fax:
Practice Address - Street 1:3471 N FEDERAL HWY STE 508
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1052
Practice Address - Country:US
Practice Address - Phone:954-321-1980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7948103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty