MEDICARE: JESSICA MARIE BRIGANTE LCSW

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
1	1041C0700X	Clinical Social Worker	44SC06627100	NJ
2	104100000X	Social Worker	110796	NY
3	1041C0700X	Clinical Social Worker	16414	CT
4	1041C0700X	Clinical Social Worker	101669	NY

General Provider Information

NPI Number	:	1215536727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE BRIGANTE LCSW

Provider Business Mailing Address
First Line	:	204 AIRPORT PLAZA BLVD # 1116
Second Line	:
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-3946
Country	:	US
Telephone Number	:	516-200-1633
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 AIRPORT PLAZA BLVD # 1116
Second Line	:
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-3946
Country	:	US
Telephone Number	:	516-200-1633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	06/02/2026

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