Healthcare Provider Details

I. General information

NPI: 1598647273
Provider Name (Legal Business Name): BRANDON LEE MARRERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 3RD AVE
BRONX NY
10457-2562
US

IV. Provider business mailing address

4419 3RD AVE
BRONX NY
10457-2562
US

V. Phone/Fax

Practice location:
  • Phone: 718-364-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP137248
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: