Provider Demographics
NPI:1235737768
Name:PETOVELLO, TONI ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:TONI ANN
Middle Name:
Last Name:PETOVELLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5228
Mailing Address - Country:US
Mailing Address - Phone:718-440-6731
Mailing Address - Fax:
Practice Address - Street 1:6036 76TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-5228
Practice Address - Country:US
Practice Address - Phone:718-440-6731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106161104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker