Healthcare Provider Details

I. General information

NPI: 1093538621
Provider Name (Legal Business Name): BRIANNA VIGORITO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 THROOP AVE # 11206
BROOKLYN NY
11206-5334
US

IV. Provider business mailing address

1191 HALSEY ST LOWR LVL
BROOKLYN NY
11207-2673
US

V. Phone/Fax

Practice location:
  • Phone: 929-210-9333
  • Fax:
Mailing address:
  • Phone: 973-270-8246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: