Provider Demographics
NPI:1821426677
Name:BRAZELL, AMY M (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:BRAZELL
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6414 FANTAIL LN
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8617
Mailing Address - Country:US
Mailing Address - Phone:315-345-6659
Mailing Address - Fax:
Practice Address - Street 1:520 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2302
Practice Address - Country:US
Practice Address - Phone:315-435-7706
Practice Address - Fax:315-435-7715
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730807771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical