Provider Demographics
NPI:1912476953
Name:REEDY, BRIANNA LEE (MSW)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LEE
Last Name:REEDY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 JAMES ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2681
Mailing Address - Country:US
Mailing Address - Phone:315-671-2964
Mailing Address - Fax:
Practice Address - Street 1:635 JAMES ST STE 2
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2681
Practice Address - Country:US
Practice Address - Phone:315-671-2964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP13817104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker