Provider Demographics
NPI:1881881084
Name:FISHER, BRYON EUGENE (BA, CASAC)
Entity type:Individual
Prefix:
First Name:BRYON
Middle Name:EUGENE
Last Name:FISHER
Suffix:
Gender:M
Credentials:BA, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4254 SOWERBY RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14550-9721
Mailing Address - Country:US
Mailing Address - Phone:585-237-2711
Mailing Address - Fax:
Practice Address - Street 1:422 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1023
Practice Address - Country:US
Practice Address - Phone:585-786-8133
Practice Address - Fax:585-786-9928
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13148101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00740423Medicaid