Provider Demographics
NPI:1548490121
Name:CEMELLI, BRENDA F (LMHC, LPC, CASAC,)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:F
Last Name:CEMELLI
Suffix:
Gender:F
Credentials:LMHC, LPC, CASAC,
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:F
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, LPC, CASAC
Mailing Address - Street 1:2198 BRUYNSWICK RD
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-3286
Mailing Address - Country:US
Mailing Address - Phone:845-264-9321
Mailing Address - Fax:
Practice Address - Street 1:2198 BRUYNSWICK RD
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-3286
Practice Address - Country:US
Practice Address - Phone:845-264-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004635101YM0800X
NY004881-1101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467448571Medicaid