Provider Demographics
NPI:1447069778
Name:DEWHIRST, BRIANNA E
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:E
Last Name:DEWHIRST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7933 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FABIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13063-8722
Mailing Address - Country:US
Mailing Address - Phone:315-569-9739
Mailing Address - Fax:
Practice Address - Street 1:7933 MAIN ST
Practice Address - Street 2:
Practice Address - City:FABIUS
Practice Address - State:NY
Practice Address - Zip Code:13063-8722
Practice Address - Country:US
Practice Address - Phone:315-569-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health