MEDICARE: MRS. MONICA V BRIGNOLO 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	R046222-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	274655	OTHER	NY	HMC ID

General Provider Information

NPI Number	:	1255342309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONICA V BRIGNOLO LCSW

Provider Business Mailing Address
First Line	:	14101 68TH DR
Second Line	:
City	:	KEW GARDENS HILLS
State	:	NY
Zip	:	11367-1635
Country	:	US
Telephone Number	:	718-520-0798
Fax Number	:

Provider Business Practice Location Address
First Line	:	14101 68TH DR
Second Line	:
City	:	KEW GARDENS HILLS
State	:	NY
Zip	:	11367-1635
Country	:	US
Telephone Number	:	718-520-0798
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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