1932335494 NPI number — EILEEN TERESA DENICOLO LCSW

Table of content: EILEEN TERESA DENICOLO LCSW (NPI 1932335494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932335494 NPI number — EILEEN TERESA DENICOLO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENICOLO
Provider First Name:
EILEEN
Provider Middle Name:
TERESA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRADY
Provider Other First Name:
EILEEN
Provider Other Middle Name:
TERESA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932335494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-698-5511
Provider Business Mailing Address Fax Number:
516-418-5377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 TYBURN LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH SETAUKET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-698-5511
Provider Business Practice Location Address Fax Number:
516-418-5377
Provider Enumeration Date:
06/10/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  084416 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)