Provider Demographics
NPI:1295213080
Name:PELLICCI, GINA (LMSW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:PELLICCI
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 1:50 DAYTON LN STE 205
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2860
Mailing Address - Country:US
Mailing Address - Phone:914-736-3371
Mailing Address - Fax:
Practice Address - Street 1:50 DAYTON LN STE 205
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2860
Practice Address - Country:US
Practice Address - Phone:914-736-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104633104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132793295Medicaid