Healthcare Provider Details

I. General information

NPI: 1730925256
Provider Name (Legal Business Name): BRANDI LEIGH PETRELLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRANDI LEIGH ROBINSON LMSW

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4736 ONONDAGA BLVD
SYRACUSE NY
13219-3304
US

IV. Provider business mailing address

3485 PAUL AVE
WARNERS NY
13164-9753
US

V. Phone/Fax

Practice location:
  • Phone: 315-872-2256
  • Fax:
Mailing address:
  • Phone: 315-225-6756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number115631-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102030-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: