Provider Demographics
NPI:1467769810
Name:PERCACCIO, LINA (MS ED)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:PERCACCIO
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JOLINE LANE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307
Mailing Address - Country:US
Mailing Address - Phone:718-984-7900
Mailing Address - Fax:
Practice Address - Street 1:10 JOLINE LANE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307
Practice Address - Country:US
Practice Address - Phone:781-984-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool