Provider Demographics
NPI:1417299256
Name:FEFFERMAN, BRIAN S (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:FEFFERMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2101
Mailing Address - Country:US
Mailing Address - Phone:516-735-0251
Mailing Address - Fax:
Practice Address - Street 1:2553 BEECH ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2101
Practice Address - Country:US
Practice Address - Phone:516-735-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084440-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical