MEDICARE: DR. LUIS BRIGNOLO LMHC

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	225700000X	Massage Therapist	027228	NY
2	251S00000X	Community/Behavioral Health Agency
3	101YM0800X	Mental Health Counselor	008172	NY

General Provider Information

NPI Number	:	1710139274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS BRIGNOLO LMHC

Provider Business Mailing Address
First Line	:	14101 68TH DR
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-1635
Country	:	US
Telephone Number	:	718-551-1868
Fax Number	:

Provider Business Practice Location Address
First Line	:	14101 68TH DR FL 1
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-1635
Country	:	US
Telephone Number	:	718-551-1868
Fax Number	:

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

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	09/09/2019

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