Provider Demographics
NPI:1427426253
Name:TOSOV, BRANDON (LCSW)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:TOSOV
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 BROADWAY AVE APT 201B
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4946
Mailing Address - Country:US
Mailing Address - Phone:631-317-4079
Mailing Address - Fax:
Practice Address - Street 1:24 BELLEMEADE AVE STE 24-102
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1855
Practice Address - Country:US
Practice Address - Phone:631-317-4079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY099048-1104100000X
NY0909591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker