Provider Demographics
NPI:1225129729
Name:PIECHUCKI, RITA (LCSW ACSW)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:
Last Name:PIECHUCKI
Suffix:
Gender:F
Credentials:LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CHICKEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-2618
Mailing Address - Country:US
Mailing Address - Phone:516-676-1902
Mailing Address - Fax:516-676-1901
Practice Address - Street 1:300 CHICKEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-2618
Practice Address - Country:US
Practice Address - Phone:516-676-1902
Practice Address - Fax:516-676-1901
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032191104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN51081Medicare ID - Type Unspecified