Healthcare Provider Details

I. General information

NPI: 1912885898
Provider Name (Legal Business Name): BRANDON RICHIE BHAROSE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MELROSE AVE
BRONX NY
10451-5757
US

IV. Provider business mailing address

491 VANDALIA AVE APT 4B
BROOKLYN NY
11239-2032
US

V. Phone/Fax

Practice location:
  • Phone: 917-473-6996
  • Fax:
Mailing address:
  • Phone: 347-984-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number127458-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: