Provider Demographics
NPI:1053509646
Name:PIGNATELLO, GARY D (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:D
Last Name:PIGNATELLO
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 LATHROP AVE
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-2240
Mailing Address - Country:US
Mailing Address - Phone:973-879-6206
Mailing Address - Fax:
Practice Address - Street 1:435 LATHROP AVE
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-2240
Practice Address - Country:US
Practice Address - Phone:973-879-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052039001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical