Provider Demographics
NPI:1164589503
Name:GIAMPETRUZZI, MARY ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY ANNE
Middle Name:
Last Name:GIAMPETRUZZI
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 1:10011 67TH RD
Mailing Address - Street 2:226
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2754
Mailing Address - Country:US
Mailing Address - Phone:917-716-6578
Mailing Address - Fax:718-459-3059
Practice Address - Street 1:80 E 11TH ST
Practice Address - Street 2:201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6811
Practice Address - Country:US
Practice Address - Phone:917-716-6578
Practice Address - Fax:718-459-3059
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYSR047541-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13-4162975OtherEIN
NY13-4162975OtherEIN