Healthcare Provider Details

I. General information

NPI: 1700507944
Provider Name (Legal Business Name): ZACHARY JAMES BRELAND LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18730 GRAND CENTRAL PKWY
JAMAICA NY
11432-5819
US

IV. Provider business mailing address

2426 BAYVIEW AVE
WANTAGH NY
11793-4348
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-2931
  • Fax:
Mailing address:
  • Phone: 718-877-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116904-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: