Provider Demographics
NPI:1831309715
Name:IMBERTI, PRISKA (LCSW)
Entity Type:Individual
Prefix:
First Name:PRISKA
Middle Name:
Last Name:IMBERTI
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 1:1335 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-4729
Mailing Address - Country:US
Mailing Address - Phone:631-888-0215
Mailing Address - Fax:631-888-0431
Practice Address - Street 1:72 GUY LOMBARDO AVE
Practice Address - Street 2:SUITE # 2
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3742
Practice Address - Country:US
Practice Address - Phone:516-623-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075579-11041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool