Provider Demographics
NPI:1417036609
Name:GATTUSO, CHRISTINE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:GATTUSO
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 1:705 LATTINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:NY
Mailing Address - Zip Code:12547-5311
Mailing Address - Country:US
Mailing Address - Phone:845-392-6670
Mailing Address - Fax:845-795-5850
Practice Address - Street 1:521 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1609
Practice Address - Country:US
Practice Address - Phone:845-392-6670
Practice Address - Fax:845-795-5850
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR059551-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR059551-1OtherLCSW-R LICENSE NUMBER
NY02314318Medicaid
NY1437562816OtherGROUP
NY1417036607OtherINDIVIDUAL NPI