Provider Demographics
NPI:1962053629
Name:BRAGANCA, SOCORRO (LMHC)
Entity type:Individual
Prefix:MR
First Name:SOCORRO
Middle Name:
Last Name:BRAGANCA
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 1:524 W 59TH STREET
Mailing Address - Street 2:NEW BUILDING, ROOM NO L. 68
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:914-874-7338
Mailing Address - Fax:
Practice Address - Street 1:2 W 46TH ST STE 900
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4502
Practice Address - Country:US
Practice Address - Phone:914-874-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health