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Organization
LCSW INTERVENTIONS FOR EMOTIONAL GROWTH, PC
Active
Organization
LCSW INTERVENTIONS FOR EMOTIONAL GROWTH, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA BRIGNOLO LCSW (CLINICAL DIRECTOR)
(718) 520-0798
Entity
Organization
Contact information
Practice address
14101 68TH DR, SUITE A, KEW GARDENS HILLS, NY 11367-1635
(718) 520-0798
Mailing address
14101 68TH DR, SUITE A, KEW GARDENS HILLS, NY 11367-1635
(718) 520-0798
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
RO46222
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000600019133
HEALTH PLUS/ FAMILY HEALTH PLUS/ CHILD HEALTH PLUS
NY
05
—
02864693
—
NY
01
—
11699877
CAQH UNIVERSAL CREDENTIALS
NY
01
—
274655
MHN PIN
NY
01
—
9865705
AETNA PIN
NY
Enumeration date
05/10/2012
Last updated
05/10/2012
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