Provider Demographics
NPI:1356619910
Name:EPEL, BRYAN DAVID (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DAVID
Last Name:EPEL
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 1:151 6TH ST UNIT 287
Mailing Address - Street 2:
Mailing Address - City:VERPLANCK
Mailing Address - State:NY
Mailing Address - Zip Code:10596-7735
Mailing Address - Country:US
Mailing Address - Phone:516-425-3241
Mailing Address - Fax:
Practice Address - Street 1:151 6TH ST UNIT 287
Practice Address - Street 2:
Practice Address - City:VERPLANCK
Practice Address - State:NY
Practice Address - Zip Code:10596-7735
Practice Address - Country:US
Practice Address - Phone:516-400-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0808171041C0700X
PA0808171041C0700X
NJ0808171041C0700X
NY0808171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1831721422Medicaid