Healthcare Provider Details

I. General information

NPI: 1255702379
Provider Name (Legal Business Name): THALIA BRITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2367-69 SECOND AVE
NEW YORK NY
10035
US

IV. Provider business mailing address

518 WEST 161 ST APT 15
NEW YORK NY
10032
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-2300
  • Fax: 212-722-7618
Mailing address:
  • Phone: 917-736-7478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: