Doctor Name: | BRENDA DEESSO |
NPI Number: | 1487055778 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW-R |
License Number: | 078220-1 |
Business Practice Address: | 21 Laurel Ave Suite 290 Cornwall, NY - 125181469 |
Business Phone Number: | 8454584557 |
Business Fax Number: | |
Mailing Address: | 21 Laurel Ave, Suite 290 CORNWALL |
State: | NY |
Postal Code: | 125181469 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/06/2014 |
NPI Last Update Date: | 09/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 078220-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |