Provider Demographics
NPI:1003976515
Name:DARMIENTO, ELLIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLIE
Middle Name:
Last Name:DARMIENTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12516 83RD DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1901
Mailing Address - Country:US
Mailing Address - Phone:718-849-3971
Mailing Address - Fax:
Practice Address - Street 1:12516 83RD DR APT 1B
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1901
Practice Address - Country:US
Practice Address - Phone:718-849-3971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR029447-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical