Provider Demographics
NPI:1871076406
Name:BREYTA PSYCHOLOGICAL SERVICES, P.A.
Entity type:Organization
Organization Name:BREYTA PSYCHOLOGICAL SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:HANDSEL
Authorized Official - Last Name:RODDENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-245-7791
Mailing Address - Street 1:8303 SIX FORKS RD STE 207
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3094
Mailing Address - Country:US
Mailing Address - Phone:919-245-7791
Mailing Address - Fax:919-867-2786
Practice Address - Street 1:8303 SIX FORKS RD STE 207
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3094
Practice Address - Country:US
Practice Address - Phone:919-245-7791
Practice Address - Fax:919-867-2786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty