Provider Demographics
NPI:1558355966
Name:MUCCIO, DOROTHY (CSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:MUCCIO
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3105
Mailing Address - Country:US
Mailing Address - Phone:212-633-0800
Mailing Address - Fax:212-691-2786
Practice Address - Street 1:16 E 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3105
Practice Address - Country:US
Practice Address - Phone:212-633-0800
Practice Address - Fax:212-691-2786
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0593751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY059375OtherLICENSE