Provider Demographics
NPI:1609025436
Name:BRISSON, LUCIEN M (CASAC)
Entity Type:Individual
Prefix:MR
First Name:LUCIEN
Middle Name:M
Last Name:BRISSON
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-5706
Mailing Address - Country:US
Mailing Address - Phone:718-485-7655
Mailing Address - Fax:718-485-7667
Practice Address - Street 1:480 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5706
Practice Address - Country:US
Practice Address - Phone:718-485-7655
Practice Address - Fax:718-485-7667
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17838101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)