Provider Demographics
NPI:1225017213
Name:GERETY, BRIAN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:GERETY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-2001
Mailing Address - Country:US
Mailing Address - Phone:914-242-0725
Mailing Address - Fax:914-242-5152
Practice Address - Street 1:333 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-2001
Practice Address - Country:US
Practice Address - Phone:914-242-0725
Practice Address - Fax:914-242-5152
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR028088104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker