Provider Demographics
NPI:1144239484
Name:GIANNELLI-O'BRIEN, BARBARA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:GIANNELLI-O'BRIEN
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 1:3771 NESCONSET HWY STE 208A
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1154
Mailing Address - Country:US
Mailing Address - Phone:631-751-9600
Mailing Address - Fax:
Practice Address - Street 1:3771 NESCONSET HWY STE 208A
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1154
Practice Address - Country:US
Practice Address - Phone:631-751-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040503-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV21387OtherVYTRA VALUE OPTIONS
NYN74481Medicare ID - Type Unspecified