Provider Demographics
NPI:1396832838
Name:LUCIANO, ALEJANDRO ALEXIS (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:ALEXIS
Last Name:LUCIANO
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 RESERVOIR OVAL
Mailing Address - Street 2:MONTEFIORE SCHOOL HEALTH PROGRAM
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-549-8022
Mailing Address - Fax:718-549-7977
Practice Address - Street 1:100 WEST MOSHULU PARKWAY SOUTH
Practice Address - Street 2:DEWITT CLINTON HIGH SCHOOL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:718-549-8022
Practice Address - Fax:718-549-7977
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125184104100000X
NY077594104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400031571Medicare PIN