MEDICARE: BRYAN BATISTA-THOMAS LCSW

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1568971000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN BATISTA-THOMAS LCSW

Provider Business Mailing Address
First Line	:	303 5TH AVE RM 1816
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-6601
Country	:	US
Telephone Number	:	929-430-7285
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 5TH AVE RM 1816
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-6601
Country	:	US
Telephone Number	:	929-430-7285
Fax Number	:

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

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	05/02/2022

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