Provider Demographics
NPI:1851491856
Name:PISANO, ELMA G (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:ELMA
Middle Name:G
Last Name:PISANO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 E MAIN ST STE LL5
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2980
Mailing Address - Country:US
Mailing Address - Phone:631-724-0600
Mailing Address - Fax:631-724-0606
Practice Address - Street 1:285 E MAIN ST STE LL5
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2980
Practice Address - Country:US
Practice Address - Phone:631-724-0600
Practice Address - Fax:631-724-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0769491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical