Healthcare Provider Details

I. General information

NPI: 1366365462
Provider Name (Legal Business Name): LUCY R BREIDENTHAL MFT-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LAFAYETTE ST FL 5
NEW YORK NY
10013-4116
US

IV. Provider business mailing address

440 SAINT NICHOLAS AVE APT 5C
NEW YORK NY
10027-7632
US

V. Phone/Fax

Practice location:
  • Phone: 513-335-7145
  • Fax:
Mailing address:
  • Phone: 513-335-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberP139715
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: