Provider Demographics
NPI:1770649733
Name:YARCAG, BRENDA (CSWR)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:YARCAG
Suffix:
Gender:F
Credentials:CSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1415
Mailing Address - Country:US
Mailing Address - Phone:315-244-3078
Mailing Address - Fax:
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1415
Practice Address - Country:US
Practice Address - Phone:315-379-9162
Practice Address - Fax:315-379-9162
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05070111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical