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General NPI Number Information
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NPI Number | 1588948426
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Entity Type | Individual
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Provider Name | GARY BISOGNA LMHC, CEAP
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Gender | Male
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 2285 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6625
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Country | US
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Telephone | 718-637-3934
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Fax |
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Provider Business Mailing Address
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Address Line | 174 WOOLLEY AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-2646
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Country | US
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Telephone | 718-637-3934
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Fax | 718-667-2498
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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 | 000907
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License Number State | NY
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