Provider Demographics
NPI:1902019862
Name:PANSULLA, LOUIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:
Last Name:PANSULLA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 W 24TH ST
Mailing Address - Street 2:SUITE 910
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3206
Mailing Address - Country:US
Mailing Address - Phone:212-633-8070
Mailing Address - Fax:
Practice Address - Street 1:49 W 24TH ST
Practice Address - Street 2:SUITE 910
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3206
Practice Address - Country:US
Practice Address - Phone:212-633-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056598-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP979822OtherOXFORD INSURANCE