Provider Demographics
NPI:1922112655
Name:PERRETTA, ELIZABETH (LCSW-R, MASTER CASAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PERRETTA
Suffix:
Gender:F
Credentials:LCSW-R, MASTER CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 BRADLEY PL
Mailing Address - Street 2:APT. 4S
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3719
Mailing Address - Country:US
Mailing Address - Phone:516-444-6038
Mailing Address - Fax:
Practice Address - Street 1:99 BRADLEY PL
Practice Address - Street 2:4S
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3719
Practice Address - Country:US
Practice Address - Phone:516-444-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066270-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical