Provider Demographics
NPI:1154536852
Name:BRIMO, MARCELLA LORRAINE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:LORRAINE
Last Name:BRIMO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:352 SPRINGVILLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2858
Mailing Address - Country:US
Mailing Address - Phone:716-834-3015
Mailing Address - Fax:
Practice Address - Street 1:BUFFALO GENERAL HOSPITAL
Practice Address - Street 2:80 GOODRICH STREET
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-859-4573
Practice Address - Fax:716-859-2560
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046250-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical