Mary Bragoli
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Hampton Bays, NY
NPI 1083735302 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1083735302
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 8150 (NY)
- Practice address
- 31 E Montauk Hwy
Hampton Bays, NY 11946-1816 - Phone
- (631) 723-3362
- NPI assigned
- Apr 3, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8150 | NY | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catholic Charities of the Diocese of Rockville Centre | Past | Accepting new patients | |
| Catholic Charities of the Diocese of Rockville Centre | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 8150 | NY | Yes |
Addresses
Primary practice location
31 E Montauk Hwy
Hampton Bays, NY 11946-1816
Mailing address
7 Ocean Ave
Hampton Bays, NY 11946-2322
Phone (631) 723-3362
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02249145 | Medicaid | NY |
Other providers in Hampton Bays, NY
- Emilia Berry
- Christopher R Bickford
- Robert N Bickford
- Scott Bolster
- Grace Brackemyre
- Megan Brandow
- Maureen Ellen Brenner
- August Marie Brown
- John Bruno
- Maria Bruno
All providers in Hampton Bays, NY · Addiction (Substance Use Disorder) Counselor in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.