Provider Demographics
NPI:1588678809
Name:PETILLO, DARREN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:
Last Name:PETILLO
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 1:5 HUNDLEY CT
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3923
Mailing Address - Country:US
Mailing Address - Phone:201-759-9091
Mailing Address - Fax:201-759-9091
Practice Address - Street 1:31 IMPERIAL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4303
Practice Address - Country:US
Practice Address - Phone:201-759-9091
Practice Address - Fax:201-759-9091
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical