Provider Demographics
NPI:1144651621
Name:FEGARSKY, BRIANNE (LMSW, CASAC-T)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:FEGARSKY
Suffix:
Gender:F
Credentials:LMSW, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-7803
Mailing Address - Country:US
Mailing Address - Phone:845-422-5962
Mailing Address - Fax:
Practice Address - Street 1:140 ROUTE 303 STE J
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-5907
Practice Address - Country:US
Practice Address - Phone:845-267-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
NY081307104100000X
NJ44SL05760000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)