Provider Demographics
NPI:1376012989
Name:BRITO-D'ORTA, CONCITA
Entity Type:Individual
Prefix:
First Name:CONCITA
Middle Name:
Last Name:BRITO-D'ORTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BIRCHWOOD CT APT 2K
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4515
Mailing Address - Country:US
Mailing Address - Phone:516-851-5561
Mailing Address - Fax:
Practice Address - Street 1:5 BIRCHWOOD CT APT 2K
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4515
Practice Address - Country:US
Practice Address - Phone:516-851-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician