MEDICARE: MR. LENNOX GODWIN DEBARROS NURSE PRACTITIONER

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
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	400814	NY

General Provider Information

NPI Number	:	1396832366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LENNOX GODWIN DEBARROS NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	640 WILLIS ST
Second Line	:
City	:	SOUTH HEMPSTEAD
State	:	NY
Zip	:	11550-8000
Country	:	US
Telephone Number	:	516-385-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	640 WILLIS ST
Second Line	:
City	:	SOUTH HEMPSTEAD
State	:	NY
Zip	:	11550
Country	:	US
Telephone Number	:	516-385-6611
Fax Number	:

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	06/21/2018

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