Provider Demographics
NPI:1497796825
Name:PASSARO, MARIO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:PASSARO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 GRAMATAN AVE
Mailing Address - Street 2:APT 2 -F
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1840
Mailing Address - Country:US
Mailing Address - Phone:914-665-1218
Mailing Address - Fax:914-235-0822
Practice Address - Street 1:481 MAIN ST
Practice Address - Street 2:SUITE 403-A
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-6324
Practice Address - Country:US
Practice Address - Phone:914-912-4859
Practice Address - Fax:914-235-0822
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY53433431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNQ525Medicare ID - Type UnspecifiedMEDICARE