Provider Demographics
NPI:1972005833
Name:CENTER FOR LEARNING AND GROWTH HEALTH AND WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:CENTER FOR LEARNING AND GROWTH HEALTH AND WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGNOLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-551-1868
Mailing Address - Street 1:14101 68TH DR FL 1
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008172101YM0800X
NY027228225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty