Most Relevant Information
Provider Data
| NPI Number: | 1003687914 |
| Provider Name: | BREANNA MARIE ECONOMOS |
| Entity Type: | Individual |
| Taxonomy Code: | 106H00000X |
| Specialty: | Marriage & Family Therapist |
| License Number: | P126356 |
Most Important Dates
| Enumeration Date: | 01/10/2024 |
| Last Updated: | 01/10/2024 |
Provider Practice Location
2290 9TH AVE
RONKONKOMA
NY
117796277
Practice Location Phone/Fax
| Phone: | 6317086257 |
| Fax: |
Provider Mailing Location
2290 9TH AVE
RONKONKOMA
NY
117796277
Provider Mailing Phone/Fax
| Phone: | 6317086257 |
| Fax: |