MEDICARE: KIMBERLY BRANDL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PO3869	NY

General Provider Information

NPI Number	:	1003323262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BRANDL

Provider Business Mailing Address
First Line	:	141 COUNTY ROUTE 23A
Second Line	:
City	:	CONSTANTIA
State	:	NY
Zip	:	13044-3737
Country	:	US
Telephone Number	:	315-204-0610
Fax Number	:	315-260-4332

Provider Business Practice Location Address
First Line	:	202 WALTON ST STE 200
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13202-1373
Country	:	US
Telephone Number	:	315-204-0610
Fax Number	:	315-260-4332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2018
Last Update Date	:	12/30/2025

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Directions to “ KIMBERLY BRANDL ” Practice Location

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