Provider Demographics
NPI:1841394087
Name:MARRIS, BRENDA LYNNE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LYNNE
Last Name:MARRIS
Suffix:
Gender:F
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 1:2 WILLIAMS ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1706
Mailing Address - Country:US
Mailing Address - Phone:315-859-1481
Mailing Address - Fax:315-839-6007
Practice Address - Street 1:2 WILLIAMS ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1706
Practice Address - Country:US
Practice Address - Phone:315-859-1481
Practice Address - Fax:315-839-6007
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046229-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical