Provider Demographics
NPI:1508137365
Name:NITTOLI, BARBARA L (LMSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:NITTOLI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HART ST
Mailing Address - Street 2:4TH FLOOR YOUNG MOTHER'S PROGRAM
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-1122
Mailing Address - Country:US
Mailing Address - Phone:585-233-1267
Mailing Address - Fax:
Practice Address - Street 1:30 HART ST
Practice Address - Street 2:4TH FLOOR YOUNG MOTHER'S PROGRAM
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-1122
Practice Address - Country:US
Practice Address - Phone:585-233-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0349311041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034931Medicaid