Provider Demographics
NPI:1952011751
Name:SCULLY, BRIANNA (LMSW)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:SCULLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FERNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3008
Mailing Address - Country:US
Mailing Address - Phone:516-410-4407
Mailing Address - Fax:
Practice Address - Street 1:215 OLD RIVERHEAD RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1206
Practice Address - Country:US
Practice Address - Phone:631-288-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1173891041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool