MEDICARE: LORRAINE BRANCALE

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	PO8285	NY

General Provider Information

NPI Number	:	1477051852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE BRANCALE

Provider Business Mailing Address
First Line	:	384 BARD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	384 BARD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2102
Country	:	US
Telephone Number	:	347-850-2585
Fax Number	:

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

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	01/31/2018

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Directions to “ LORRAINE BRANCALE ” Practice Location

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