Provider Demographics
NPI:1538537238
Name:BRIZAN, BENEDICT
Entity type:Individual
Prefix:MR
First Name:BENEDICT
Middle Name:
Last Name:BRIZAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BENEDICT
Other - Middle Name:
Other - Last Name:BRIZAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW R
Mailing Address - Street 1:934 E 106TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3012
Mailing Address - Country:US
Mailing Address - Phone:347-801-3563
Mailing Address - Fax:718-221-7240
Practice Address - Street 1:934 E 106TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3012
Practice Address - Country:US
Practice Address - Phone:347-801-3563
Practice Address - Fax:718-221-7240
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0733011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical