Healthcare Provider Details

I. General information

NPI: 1326828880
Provider Name (Legal Business Name): PATRICIA IANNICO MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 REMSEN ST STE 1010
BROOKLYN NY
11201-4300
US

IV. Provider business mailing address

175 REMSEN ST STE 1010
BROOKLYN NY
11201-4300
US

V. Phone/Fax

Practice location:
  • Phone: 718-852-5552
  • Fax: 718-852-5666
Mailing address:
  • Phone: 718-852-5552
  • Fax: 718-852-5666

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: