Provider Demographics
NPI:1013030972
Name:SIGNORELLA, NUNZIO (LCSW, CASAC)
Entity Type:Individual
Prefix:MR
First Name:NUNZIO
Middle Name:
Last Name:SIGNORELLA
Suffix:
Gender:M
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 72ND ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2661
Mailing Address - Country:US
Mailing Address - Phone:347-675-9873
Mailing Address - Fax:585-539-1021
Practice Address - Street 1:300 W 72ND ST APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2661
Practice Address - Country:US
Practice Address - Phone:347-675-9873
Practice Address - Fax:585-539-1021
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13192101YA0400X
NY0824931041C0700X
NY067599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02542107Medicaid
NYQ03275Medicare UPIN
NY02542107Medicaid