MEDICARE: BRIANNA SCULLEY LMSW

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

General Provider Information

NPI Number	:	1851811384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA SCULLEY LMSW

Provider Business Mailing Address
First Line	:	51 JANE ST APT 19
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-5174
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 COURT ST STE 1306
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11242-1113
Country	:	US
Telephone Number	:	917-887-6007
Fax Number	:

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

Provider Enumeration Date	:	06/26/2017
Last Update Date	:	06/26/2017

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