Provider Demographics
NPI:1447572300
Name:CADICAMO, BRYAN W (LCSWR)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:W
Last Name:CADICAMO
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 ROUTE 9 STE 7
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4993
Mailing Address - Country:US
Mailing Address - Phone:845-240-6204
Mailing Address - Fax:845-632-2940
Practice Address - Street 1:1285 ROUTE 9
Practice Address - Street 2:STE 7
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4993
Practice Address - Country:US
Practice Address - Phone:845-240-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0535261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1447572300Medicaid