Healthcare Provider Details

I. General information

NPI: 1023196383
Provider Name (Legal Business Name): BRENDA M. VEILLEUX LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 11/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 NORTH PARK STREET 2ND FL.
SENECA FALLS NY
13148-1347
US

IV. Provider business mailing address

12 NORTH PARK STREET, SENECA FALLS, NY 3148
SENECA FALLS NY
13148
US

V. Phone/Fax

Practice location:
  • Phone: 315-568-9412
  • Fax: 315-568-6718
Mailing address:
  • Phone: 315-568-9412
  • Fax: 315-568-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0748171
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: