Healthcare Provider Details

I. General information

NPI: 1881881084
Provider Name (Legal Business Name): BRYON EUGENE FISHER BA, CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N MAIN ST
WARSAW NY
14569-1023
US

IV. Provider business mailing address

4254 SOWERBY RD
SILVER SPRINGS NY
14550-9721
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-8133
  • Fax: 585-786-9928
Mailing address:
  • Phone: 585-237-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13148
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: