Provider Demographics
NPI:1962190249
Name:CASANOVAS, BRIAN FLYNN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:FLYNN
Last Name:CASANOVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK AVE FL 16
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5538
Mailing Address - Country:US
Mailing Address - Phone:212-433-2384
Mailing Address - Fax:
Practice Address - Street 1:343 E 65TH ST APT 4RE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6861
Practice Address - Country:US
Practice Address - Phone:917-353-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118708104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker