Provider Demographics
NPI:1861857781
Name:MENTRY, BRYAN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:MENTRY
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 MILLENNIUM DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1192
Mailing Address - Country:US
Mailing Address - Phone:585-243-4592
Mailing Address - Fax:585-243-3668
Practice Address - Street 1:4500 MILLENNIUM DR
Practice Address - Street 2:SUITE I
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1192
Practice Address - Country:US
Practice Address - Phone:585-243-4592
Practice Address - Fax:585-243-3668
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0559691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical