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Individual

BRYAN LACKEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PMHNP-BC

Contact information

Practice address
230 PARK AVE FL 3, NEW YORK, NY 10169-0018
(516) 505-7200
(949) 419-3482
Mailing address
230 PARK AVE FL 3, NEW YORK, NY 10169-0018
(347) 861-6651
(949) 419-3482

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
26NJ01045800
NJ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403117
NY

Other

Enumeration date
08/06/2020
Last updated
08/14/2022
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