| Lcsw Interventions For Emotional Growth, Pc | |
|
14101 68th Dr Suite A Kew Gardens Hills NY 11367-1635 | |
| (718) 520-0798 | |
| Not Available |
| Full Name | Lcsw Interventions For Emotional Growth, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 14101 68th Dr, Kew Gardens Hills, New York |
| Authorized Official Name and Position | Monica Brignolo (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7185200798 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lcsw Interventions For Emotional Growth, Pc 14101 68th Dr Suite A Kew Gardens Hills NY 11367-1635 Ph: (718) 520-0798 | Lcsw Interventions For Emotional Growth, Pc 14101 68th Dr Suite A Kew Gardens Hills NY 11367-1635 Ph: (718) 520-0798 |
| NPI Number | 1114286101 |
|---|---|
| Provider Enumeration Date | 05/10/2012 |
| Last Update Date | 05/10/2012 |
| Medicare PECOS PAC ID | 0749412476 |
|---|---|
| Medicare Enrollment ID | O20140512000139 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114286101 | NPI | - | NPPES |
| 9865705 | Other | NY | AETNA PIN |
| 11699877 | Other | NY | CAQH UNIVERSAL CREDENTIALS |
| 274655 | Other | NY | MHN PIN |
| 02864693 | Medicaid | NY | |
| 000600019133 | Other | NY | HEALTH PLUS/ FAMILY HEALTH PLUS/ CHILD HEALTH PLUS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | RO46222 (New York) | Primary |
| Provider Name | Monica Brignolo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255342309 PECOS PAC ID: 6800810979 Enrollment ID: I20060117000812 |