Provider Demographics
NPI:1346746104
Name:PISCIOTTA, MILDRED (LCSW-R)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:PISCIOTTA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RIVERSIDE DR APT 15RE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-1426
Mailing Address - Country:US
Mailing Address - Phone:212-787-0426
Mailing Address - Fax:
Practice Address - Street 1:11 RIVERSIDE DR APT 15RE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-1426
Practice Address - Country:US
Practice Address - Phone:212-787-0426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0504601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical