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General NPI Number Information
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NPI Number | 1508528530
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Entity Type | Individual
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Provider Name | BRENDALIZ FADUL MHC
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Gender | Female
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 19 W 21ST ST SUITE1003
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City | NEW YORK
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State | NY
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Zip | 10010
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Country | US
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Telephone | 917-909-6806
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Fax |
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Provider Business Mailing Address
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Address Line | 41 OXFORD LN
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City | HARRIMAN
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State | NY
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Zip | 10926-3008
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Country | US
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Telephone | 845-591-8439
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 013257-01
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License Number State | NY
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