Provider Demographics
NPI:1255342309
Name:BRIGNOLO, MONICA V (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:V
Last Name:BRIGNOLO
Suffix:
Gender:F
Credentials:LCSW
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:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1635
Mailing Address - Country:US
Mailing Address - Phone:718-520-0798
Mailing Address - Fax:
Practice Address - Street 1:14101 68TH DR
Practice Address - Street 2:
Practice Address - City:KEW GARDENS HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367-1635
Practice Address - Country:US
Practice Address - Phone:718-520-0798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046222-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY274655OtherHMC ID