MEDICARE: CHRISTOPHER PACIFICO

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	001394	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001394	OTHER	NY	NEW YORK STATE

General Provider Information

NPI Number	:	1700453925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER PACIFICO

Provider Business Mailing Address
First Line	:	2580 OCEAN PKWY APT 5K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7734
Country	:	US
Telephone Number	:	917-607-2764
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 OCEAN PKWY APT 5K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7734
Country	:	US
Telephone Number	:	917-607-2764
Fax Number	:

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

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	06/07/2021

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Directions to “ CHRISTOPHER PACIFICO ” Practice Location

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