Provider Demographics
NPI:1689331035
Name:STACY PELLETTIERI
Entity Type:Organization
Organization Name:STACY PELLETTIERI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:PELLETTIERI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:516-680-5967
Mailing Address - Street 1:149 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4458
Mailing Address - Country:US
Mailing Address - Phone:516-680-5967
Mailing Address - Fax:
Practice Address - Street 1:400 JERICHO TPKE STE 104
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1320
Practice Address - Country:US
Practice Address - Phone:516-680-5967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty