Provider Demographics
NPI:1285468900
Name:FIORINA, BRENDAN JAMES (LMHC)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:JAMES
Last Name:FIORINA
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 1:115 PASSAIC AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1188
Mailing Address - Country:US
Mailing Address - Phone:845-430-7627
Mailing Address - Fax:
Practice Address - Street 1:1115 BROADWAY STE 1206
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3450
Practice Address - Country:US
Practice Address - Phone:347-541-7053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health