Provider Demographics
NPI:1073387411
Name:BRACCO, CHRISTINE (MHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BRACCO
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N VILLAGE AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CTR
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3701
Mailing Address - Country:US
Mailing Address - Phone:516-350-8564
Mailing Address - Fax:516-874-2477
Practice Address - Street 1:123 GROVE AVE STE 216
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2302
Practice Address - Country:US
Practice Address - Phone:516-350-8564
Practice Address - Fax:516-874-2477
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health