Provider Demographics
NPI:1093160152
Name:CANGIALOSI, LOUISE RINA (LCSW R)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:RINA
Last Name:CANGIALOSI
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 88TH LN
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7858
Mailing Address - Country:US
Mailing Address - Phone:917-445-3481
Mailing Address - Fax:
Practice Address - Street 1:8275 88TH LN
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7858
Practice Address - Country:US
Practice Address - Phone:917-445-3481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO54308104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker