MEDICARE: ANNA DRAKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	407259	NY

General Provider Information

NPI Number	:	1124958350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA DRAKE

Provider Business Mailing Address
First Line	:	940 BELMONT ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-5596
Country	:	US
Telephone Number	:	508-583-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 BELMONT ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-5596
Country	:	US
Telephone Number	:	508-583-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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Directions to “ ANNA DRAKE ” Practice Location

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