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NPI Code Detail

MEDICARE: MRS. JESSICA MIRABELLO LMHC

MEDICARE: MRS. JESSICA MIRABELLO 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
1101YP2500XProfessional Counselor37PC01065500NJ
2101YM0800XMental Health Counselor004593NY

General Provider Information

NPI Number : 1477060374
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA MIRABELLO LMHC
Provider Business Mailing Address
First Line : 776 RATHBUN AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10309-2409
Country : US
Telephone Number : 718-614-4943
Fax Number :
Provider Business Practice Location Address
First Line : 500 BI COUNTY BLVD STE 450
Second Line :
City : FARMINGDALE
State : NY
Zip : 11735-3995
Country : US
Telephone Number : 718-264-1640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2018
Last Update Date : 09/27/2024

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