Healthcare Provider Details

I. General information

NPI: 1639663768
Provider Name (Legal Business Name): BRANDY LAWSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 UNION CENTER MAINE HWY STE 204
ENDICOTT NY
13760-1340
US

IV. Provider business mailing address

1635 UNION CENTER MAINE HWY STE 204
ENDICOTT NY
13760-1340
US

V. Phone/Fax

Practice location:
  • Phone: 607-205-3231
  • Fax: 607-953-0294
Mailing address:
  • Phone: 607-205-3231
  • Fax: 607-953-0294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: