Provider Demographics
NPI:1538484092
Name:BRYJAK, DIANE M (MFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:BRYJAK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1108
Mailing Address - Country:US
Mailing Address - Phone:518-891-4977
Mailing Address - Fax:518-891-2863
Practice Address - Street 1:238 BROADWAY
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1108
Practice Address - Country:US
Practice Address - Phone:518-891-4977
Practice Address - Fax:518-891-2863
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-28
Last Update Date:2010-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist