Provider Demographics
NPI:1407249212
Name:RACANELLI, JOYCE ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:ANN
Last Name:RACANELLI
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 1:311 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-1924
Mailing Address - Country:US
Mailing Address - Phone:631-902-6786
Mailing Address - Fax:
Practice Address - Street 1:216 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-1222
Practice Address - Country:US
Practice Address - Phone:631-902-6786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079192-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical