MEDICARE: EASTERN SKY PSYCHOTHERAPY LCSW PC

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

General Provider Information

NPI Number	:	1467111369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN SKY PSYCHOTHERAPY LCSW PC

Provider Business Mailing Address
First Line	:	2056 E 61ST ST FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5908
Country	:	US
Telephone Number	:	929-545-0653
Fax Number	:

Provider Business Practice Location Address
First Line	:	2056 E 61ST ST FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5908
Country	:	US
Telephone Number	:	929-545-0653
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	EKATERINA LUBRANO
Credential	:	LCSW
Telephone Number	:	929-545-0653

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	12/08/2021

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