Provider Demographics
NPI:1588648000
Name:DE LELLO, ROBERT ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:DE LELLO
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 1:75 S RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-2648
Mailing Address - Country:US
Mailing Address - Phone:914-271-8161
Mailing Address - Fax:914-271-8161
Practice Address - Street 1:75 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-2648
Practice Address - Country:US
Practice Address - Phone:914-271-8161
Practice Address - Fax:914-271-8161
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0177951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN88651Medicare ID - Type Unspecified
NYN88652Medicare ID - Type Unspecified