Provider Demographics
NPI:1457010308
Name:MORA, BRIANNA (MHC-LP)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:MORA
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 VETERANS MEMORIAL HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4322
Mailing Address - Country:US
Mailing Address - Phone:631-533-0315
Mailing Address - Fax:
Practice Address - Street 1:368 VETERANS MEMORIAL HWY STE 3
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4322
Practice Address - Country:US
Practice Address - Phone:631-533-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP116565101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR198076OtherCPH AND ASSOCIATES