Provider Demographics
NPI:1851596316
Name:BREEN, JAMES R (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BREEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LINLYCO LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CATTARAUGUS
Mailing Address - State:NY
Mailing Address - Zip Code:14719-9715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LEO MOSS DR
Practice Address - Street 2:SUITE 4308
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1100
Practice Address - Country:US
Practice Address - Phone:716-373-8040
Practice Address - Fax:716-373-4820
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073309-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00635098Medicaid
NY00635098Medicaid