Provider Demographics
NPI:1609341106
Name:PETRONELLA, JANET (MSED)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:PETRONELLA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 200TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1135
Mailing Address - Country:US
Mailing Address - Phone:347-677-2300
Mailing Address - Fax:
Practice Address - Street 1:3323 200TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11361-1135
Practice Address - Country:US
Practice Address - Phone:347-677-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2019-03-10
Deactivation Date:2019-02-15
Deactivation Code:
Reactivation Date:2019-03-05
Provider Licenses
StateLicense IDTaxonomies
NY1221332104100000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker