Individual
MR. BERNARD RILEY SISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
313 N AURORA ST, ITHACA, NY 14850-4201
(607) 280-8340
Mailing address
1779 ELLIS HOLLOW RD, ITHACA, NY 14850
(607) 539-6218
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
R0396501
NY
Other
Enumeration date
01/16/2007
Last updated
07/08/2007
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