Healthcare Provider Details

I. General information

NPI: 1891235602
Provider Name (Legal Business Name): LORETTA JEANNE BRZAC MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LEAR JET LN STE 203S
LATHAM NY
12110-2322
US

IV. Provider business mailing address

3 LEAR JET LN STE 203S
LATHAM NY
12110-2322
US

V. Phone/Fax

Practice location:
  • Phone: 518-391-2680
  • Fax: 845-471-1815
Mailing address:
  • Phone: 518-391-2680
  • Fax: 845-471-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number542513
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408609
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: