MEDICARE: ANTHONY BRACCO LCSW

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	1041C0700X	Clinical Social Worker	088991	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	088991	OTHER	NY	LCSW

General Provider Information

NPI Number	:	1700333861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY BRACCO LCSW

Provider Business Mailing Address
First Line	:	157 E 86TH ST FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-2113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 E 86TH ST FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-2113
Country	:	US
Telephone Number	:	973-255-6576
Fax Number	:

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

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/16/2025

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