Healthcare Provider Details

I. General information

NPI: 1003787797
Provider Name (Legal Business Name): LINDSEY BRASGOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ARDMORE AVE
MELVILLE NY
11747-4313
US

IV. Provider business mailing address

127 ARDMORE AVE
MELVILLE NY
11747-4313
US

V. Phone/Fax

Practice location:
  • Phone: 514-979-8659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: