Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | NY |
NPI | 1093480147 |
---|---|
Provider Name | Brandon Patallo |
First Address | New York, NY 10025-1710 |
Second Address | New York, NY 10025-1710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2021 |
Last Update Date | 11/08/2021 |