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General NPI Number Information
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NPI Number | 1063246007
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Entity Type | Individual
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Provider Name | BREANNA NICOLE RIOS LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/30/2024
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 400 W MAIN ST STE 111
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City | BABYLON
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State | NY
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Zip | 11702-3009
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Country | US
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Telephone | 631-805-5668
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Fax |
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Provider Business Mailing Address
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Address Line | 17 JOHNSON CT
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City | BABYLON
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State | NY
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Zip | 11702-2409
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Country | US
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Telephone | 917-652-2917
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL07144500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 124590
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License Number State | NY
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