Provider Demographics
NPI:1851940274
Name:WILSIE, BRANDI ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:ANN
Last Name:WILSIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:ANN
Other - Last Name:WILSIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1001 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619
Mailing Address - Country:US
Mailing Address - Phone:315-493-1000
Mailing Address - Fax:315-493-0105
Practice Address - Street 1:36500 NYS ROUTE 26
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619
Practice Address - Country:US
Practice Address - Phone:315-493-5070
Practice Address - Fax:315-493-6306
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY0956041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker