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NPI Code Detail

MEDICARE: MS. BRANDI DANIELLE MACK MA-MFT, LMFT

MEDICARE: MS. BRANDI DANIELLE MACK MA-MFT, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist0009181NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073659314
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRANDI DANIELLE MACK MA-MFT, LMFT
Provider Business Mailing Address
First Line : 6018 DUNNING AVE
Second Line :
City : AUBURN
State : NY
Zip : 13021-9823
Country : US
Telephone Number : 210-291-7150
Fax Number :
Provider Business Practice Location Address
First Line : 17 E GENESEE ST STE 1
Second Line :
City : AUBURN
State : NY
Zip : 13021-4068
Country : US
Telephone Number : 315-253-9795
Fax Number : 315-253-3255
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 01/30/2020

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