Provider Demographics
NPI:1710139274
Name:BRIGNOLO, LUIS (LMHC)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:BRIGNOLO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 68TH DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1635
Mailing Address - Country:US
Mailing Address - Phone:718-551-1868
Mailing Address - Fax:
Practice Address - Street 1:14101 68TH DR FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1635
Practice Address - Country:US
Practice Address - Phone:718-551-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027228225700000X
251S00000X
NY008172101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No251S00000XAgenciesCommunity/Behavioral Health