Individual
BRIAN R AMIDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
725 IRVING AVE, SYRACUSE, NY 13210-1603
(315) 464-5538
(315) 464-5579
Mailing address
725 IRVING AVE STE 302, SYRACUSE, NY 13210-1603
(315) 464-5538
(315) 464-5579
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
072991
NY
1041C0700X
Clinical Social Worker
Primary
083385
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01649605
—
NY
Enumeration date
11/15/2006
Last updated
08/12/2015
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