MEDICARE: JOHN ANTHONY BRANCATO MHC-LP

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	101YM0800X	Mental Health Counselor	111275-01	NY

General Provider Information

NPI Number	:	1750028643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ANTHONY BRANCATO MHC-LP

Provider Business Mailing Address
First Line	:	2341 BOYNTON PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4632
Country	:	US
Telephone Number	:	917-836-9976
Fax Number	:

Provider Business Practice Location Address
First Line	:	10232 65TH AVE APT B44
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1707
Country	:	US
Telephone Number	:	347-463-8066
Fax Number	:	646-844-5961

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

Provider Enumeration Date	:	05/12/2022
Last Update Date	:	08/15/2022

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