# MODERN PSYCHIATRIC NURSE PRACTITIONER PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518415983
- **Authorized official:** BRIGHID GANNON (OWNER)
- **Authorized official phone:** (212) 734-6621

## Contact information

- **Practice address:** 1740 84TH ST, BROOKLYN, NY 11214-2825
- **Practice address phone:** (718) 855-8584
- **Mailing address:** 191 ORCHARD ST, APT. 4D, NEW YORK, NY 10002-1415
- **Mailing address phone:** (718) 757-0684

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | F401646 | NY | Yes |

## Other

- **Enumeration date:** 09/14/2016
- **Last updated:** 01/19/2023