Provider Demographics
NPI:1659926442
Name:TADDONIO, DENISE (LCSW CASAC MAC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:TADDONIO
Suffix:
Gender:F
Credentials:LCSW CASAC MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 ELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4003
Mailing Address - Country:US
Mailing Address - Phone:631-604-8081
Mailing Address - Fax:
Practice Address - Street 1:472 ELWOOD RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4003
Practice Address - Country:US
Practice Address - Phone:631-747-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084449-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty