Provider Demographics
NPI:1568569028
Name:PASSINI, ADRIANA (LCSW)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:PASSINI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84-64 AVON STREET
Mailing Address - Street 2:
Mailing Address - City:JAMAICA ESTATES
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-298-6224
Mailing Address - Fax:
Practice Address - Street 1:37-12 82 STREET
Practice Address - Street 2:232
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:212-505-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042687-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02401421Medicaid
NYP1725356OtherOXFORD
NY161995POtherHIP PRIS #
NY02401421Medicaid
NY02924Medicare ID - Type UnspecifiedGHI MEDICARE