Healthcare Provider Details

I. General information

NPI: 1801693957
Provider Name (Legal Business Name): BRANDON ALONSO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 MADISON AVE RM 1501
NEW YORK NY
10016-0701
US

IV. Provider business mailing address

274 MADISON AVE
NEW YORK NY
10016-0701
US

V. Phone/Fax

Practice location:
  • Phone: 212-203-1773
  • Fax:
Mailing address:
  • Phone: 212-203-1773
  • Fax: 646-665-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00951600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: