Provider Demographics
NPI:1225430382
Name:RELLA, PATRICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:RELLA
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:PO BOX 630423
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-0423
Mailing Address - Country:US
Mailing Address - Phone:718-423-4756
Mailing Address - Fax:
Practice Address - Street 1:24832 CAMBRIA AVE
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1230
Practice Address - Country:US
Practice Address - Phone:718-423-4756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0 50300-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical