Provider Demographics
NPI:1629740493
Name:ANNE LISCIOTTO LCSW LLC
Entity Type:Organization
Organization Name:ANNE LISCIOTTO LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LISCIOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-831-8754
Mailing Address - Street 1:204 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4324
Mailing Address - Country:US
Mailing Address - Phone:646-831-8754
Mailing Address - Fax:
Practice Address - Street 1:24 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1927
Practice Address - Country:US
Practice Address - Phone:646-831-8754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty