Healthcare Provider Details

I. General information

NPI: 1215536727
Provider Name (Legal Business Name): JESSICA MARIE BRIGANTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 AIRPORT PLAZA BLVD # 1116
FARMINGDALE NY
11735-3946
US

IV. Provider business mailing address

204 AIRPORT PLAZA BLVD # 1116
FARMINGDALE NY
11735-3946
US

V. Phone/Fax

Practice location:
  • Phone: 516-200-1633
  • Fax:
Mailing address:
  • Phone: 516-200-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06627100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110796
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16414
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: