Provider Demographics
NPI:1033301916
Name:CHRISTNELLY, SCOTT A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:CHRISTNELLY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 29TH ST APT 2J
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2817
Mailing Address - Country:US
Mailing Address - Phone:718-626-0519
Mailing Address - Fax:718-739-2525
Practice Address - Street 1:3128 41ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3902
Practice Address - Country:US
Practice Address - Phone:718-739-2525
Practice Address - Fax:718-739-2552
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074934-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical