MEDICARE: MR. BRIAN HANTZ WEST LMHC

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	101YM0800X	Mental Health Counselor	013147	NY

General Provider Information

NPI Number	:	1326709908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN HANTZ WEST LMHC

Provider Business Mailing Address
First Line	:	3375 PARK AVE STE 4006
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-3799
Country	:	US
Telephone Number	:	516-350-8564
Fax Number	:	516-874-2477

Provider Business Practice Location Address
First Line	:	3375 PARK AVE STE 4006
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-3799
Country	:	US
Telephone Number	:	516-350-8564
Fax Number	:	516-874-2477

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

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	03/27/2024

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