Provider Demographics
NPI:1801190418
Name:FUSCO, IRENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:FUSCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STUYVESANT OVAL APT 8F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2409
Mailing Address - Country:US
Mailing Address - Phone:212-475-4910
Mailing Address - Fax:
Practice Address - Street 1:4 STUYVESANT OVAL APT 8F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2409
Practice Address - Country:US
Practice Address - Phone:212-475-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73007811041C0700X
NY251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTOMJONES20Medicare PIN