Provider Demographics
NPI:1326084161
Name:PUGLIESE, NELIDA ANA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NELIDA
Middle Name:ANA
Last Name:PUGLIESE
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 1:7 SUGAR MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6249
Mailing Address - Country:US
Mailing Address - Phone:631-254-6976
Mailing Address - Fax:
Practice Address - Street 1:50 SCHOOL ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2534
Practice Address - Country:US
Practice Address - Phone:516-241-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053012-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNH2661Medicare ID - Type Unspecified