Healthcare Provider Details

I. General information

NPI: 1821030875
Provider Name (Legal Business Name): AMY ALEXANDRA BRACHFELD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FLAG LN
MANHASSET HILLS NY
11040-1018
US

IV. Provider business mailing address

24 FLAG LN
MANHASSET HILLS NY
11040-1018
US

V. Phone/Fax

Practice location:
  • Phone: 516-850-9105
  • Fax: 631-592-8415
Mailing address:
  • Phone: 516-850-9105
  • Fax: 631-592-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0707501
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier234185694
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerUBH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: