Provider Demographics
NPI:1063658102
Name:PITTELLI CIOFFI, LORETTA C (LCSW)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:C
Last Name:PITTELLI CIOFFI
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 1:111 DANIEL RD S
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2212
Mailing Address - Country:US
Mailing Address - Phone:516-579-3141
Mailing Address - Fax:516-579-3141
Practice Address - Street 1:111 DANIEL RD S
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2212
Practice Address - Country:US
Practice Address - Phone:516-579-3141
Practice Address - Fax:516-579-3141
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR#0358931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7667-2/EMPIRE IDOtherEMPIRE
NYLCSW,'R'#035893OtherNYS LIC.#