Active NPI
Phyllis Reams Brentzel, PSY. D.
- Clinical Psychologist
- North Huntingdon, PA
National Provider Identifier
1093783607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS008841L
- Practice address
- 12320 Route 30
Suites 4 & 6
North Huntingdon, PA 15642-1872 - Phone
- (724) 863-6488
- Fax
- (724) 863-6488
- NPI assigned
- Mar 9, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS008841L | PA | Primary |
Addresses
Primary practice location
12320 Route 30
Suites 4 & 6
North Huntingdon, PA 15642-1872
Mailing address
4480 Pine Hollow Rd
Trafford, PA 15085-9529
Phone (724) 863-6488
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01778104 | Medicaid | PA | |
| 151034 | Other | PA | VAUEOPTIONS |
| 349177 | Other | PA | MAGELLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS008841L | PA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vericare of Pennsylvania, P.C. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277942400000",
"number": "1093783607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4480 PINE HOLLOW RD",
"city": "TRAFFORD",
"state": "PA",
"postal_code": "150859529",
"telephone_number": "724-863-6488",
"fax_number": "724-863-6488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12320 ROUTE 30",
"address_2": "SUITES 4 & 6",
"city": "NORTH HUNTINGDON",
"state": "PA",
"postal_code": "156421872",
"telephone_number": "724-863-6488",
"fax_number": "724-863-6488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENTZEL",
"first_name": "PHYLLIS",
"middle_name": "REAMS",
"name_prefix": "Dr.",
"credential": "PSY. D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-09",
"last_updated": "2010-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS008841L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01778104",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VAUEOPTIONS",
"identifier": "151034",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "349177",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Huntingdon, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.