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General NPI Number Information
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NPI Number | 1972005833
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Entity Type | Organization
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Legal Business Name | CENTER FOR LEARNING AND GROWTH HEALTH AND WELLNESS SERVICES, LLC
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 14101 68TH DR FL 1
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City | FLUSHING
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State | NY
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Zip | 11367-1635
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Country | US
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Telephone | 718-551-1868
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Fax |
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Provider Business Mailing Address
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Address Line | 14101 68TH DR FL 1
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City | FLUSHING
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State | NY
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Zip | 11367-1635
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Country | US
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Telephone | 718-551-1868
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | DR. LUIS BRIGNOLO
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Credential | LMHC
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Telephone | 718-551-1868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 027228
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 008172
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License Number State | NY
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