Provider Demographics
NPI:1982824256
Name:MEADE, BRIAN F (CRC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:F
Last Name:MEADE
Suffix:
Gender:M
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 FRANKLIN STREET
Mailing Address - Street 2:LAKE SHORE BEHAVIORAL HEALTH
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202
Mailing Address - Country:US
Mailing Address - Phone:716-842-0220
Mailing Address - Fax:716-842-4069
Practice Address - Street 1:254 FRANKLIN STREET
Practice Address - Street 2:LAKE SHORE BEHAVIORAL HEALTH
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202
Practice Address - Country:US
Practice Address - Phone:716-842-0220
Practice Address - Fax:716-842-4069
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00050224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00671765Medicaid
NY00050224OtherCRC