Healthcare Provider Details

I. General information

NPI: 1740258490
Provider Name (Legal Business Name): MARC ANDREW BRACHFELD LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 MORTON AVE
FRANKLIN SQUARE NY
11010-3231
US

IV. Provider business mailing address

714 MORTON AVE
FRANKLIN SQUARE NY
11010-3231
US

V. Phone/Fax

Practice location:
  • Phone: 516-481-8789
  • Fax:
Mailing address:
  • Phone: 516-481-8789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000773
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: