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General NPI Number Information
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NPI Number | 1962053629
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Entity Type | Individual
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Provider Name | SOCORRO BRAGANCA LMHC
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Gender | Male
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 2 W 46TH ST STE 900
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City | NEW YORK
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State | NY
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Zip | 10036-4502
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Country | US
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Telephone | 914-874-7338
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Fax |
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Provider Business Mailing Address
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Address Line | 524 W 59TH STREET NEW BUILDING, ROOM NO L. 68
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City | NEW YORK
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State | NY
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Zip | 10019
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Country | US
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Telephone | 914-874-7338
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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 | 010512
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License Number State | NY
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