Provider Demographics
NPI:1518981117
Name:PIZZOLLO, ROCCO R (LCSW)
Entity Type:Individual
Prefix:
First Name:ROCCO
Middle Name:R
Last Name:PIZZOLLO
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 1:117 OLD LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4008
Mailing Address - Country:US
Mailing Address - Phone:518-786-8012
Mailing Address - Fax:518-782-0455
Practice Address - Street 1:117 OLD LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4008
Practice Address - Country:US
Practice Address - Phone:518-786-8012
Practice Address - Fax:518-782-0455
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033734-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01940936Medicaid
NY01940936Medicaid