Healthcare Provider Details

I. General information

NPI: 1578498754
Provider Name (Legal Business Name): BRENNA MEGAN BERCHIELLI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 SEVEN LAKES DRIVE
BEAR MOUNTAIN NY
10911
US

IV. Provider business mailing address

318 ANGOLA RD
CORNWALL NY
12518-1161
US

V. Phone/Fax

Practice location:
  • Phone: 845-233-2152
  • Fax:
Mailing address:
  • Phone: 845-220-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number022819-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: