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General NPI Number Information
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NPI Number | 1780481440
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Entity Type | Individual
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Provider Name | DANIEL BRIAN PERICO
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Gender | Male
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 459 COLUMBUS AVE UNIT 1023
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City | NEW YORK
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State | NY
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Zip | 10024-5129
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Country | US
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Telephone | 212-994-4921
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 964
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City | GOSHEN
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State | NY
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Zip | 10924-0964
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Country | US
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Telephone | 845-820-0026
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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 | P134159
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License Number State | NY
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