Provider Demographics
NPI:1437562816
Name:CHRISTINE GATTUSO, LCSW PLLC
Entity Type:Organization
Organization Name:CHRISTINE GATTUSO, LCSW PLLC
Other - Org Name:CHRISTINE GATTUSO LCSWR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GATTUSO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:845-392-6670
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 1:20 MILTON AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528
Practice Address - Country:US
Practice Address - Phone:845-392-6670
Practice Address - Fax:845-795-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR059551-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty