Healthcare Provider Details

I. General information

NPI: 1770057960
Provider Name (Legal Business Name): BRIAN DENEPITIYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 06/29/2026
Certification Date:
Deactivation Date: 11/20/2019
Reactivation Date: 06/29/2026

III. Provider practice location address

530 FRANKLIN ST FL 2
SCHENECTADY NY
12305-2011
US

IV. Provider business mailing address

530 FRANKLIN ST FL 2
SCHENECTADY NY
12305-2011
US

V. Phone/Fax

Practice location:
  • Phone: 518-545-0938
  • Fax:
Mailing address:
  • Phone: 518-545-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number105741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: