Provider Demographics
NPI:1417407628
Name:GUY PASCULLI LCSW PC
Entity Type:Organization
Organization Name:GUY PASCULLI LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PASCULLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:212-929-5729
Mailing Address - Street 1:200 WEST 18TH STREET, 5H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-929-5729
Mailing Address - Fax:
Practice Address - Street 1:200 W 18TH ST APT 5H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4521
Practice Address - Country:US
Practice Address - Phone:212-929-5729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070332305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicare PIN