=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629369491
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRACE PINTO BRITTON MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2011
-----------------------------------------------------
Last Update Date | 04/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 WOODS RD # A
-----------------------------------------------------
City | VALHALLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10595-1530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-493-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10510 PARK LN APT 113
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44106-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 261218
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------