Provider Demographics
NPI:1962766931
Name:BREWSTER, LYSA
Entity type:Individual
Prefix:
First Name:LYSA
Middle Name:
Last Name:BREWSTER
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 1:95 FRANKLIN ST
Mailing Address - Street 2:ROOM 828
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-3925
Mailing Address - Country:US
Mailing Address - Phone:716-858-7451
Mailing Address - Fax:716-858-6892
Practice Address - Street 1:95 FRANKLIN ST
Practice Address - Street 2:ROOM 828
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3925
Practice Address - Country:US
Practice Address - Phone:716-858-7451
Practice Address - Fax:716-858-6892
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator