Provider Demographics
NPI:1952491961
Name:SEVERINO, PETER (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:SEVERINO
Suffix:
Gender:M
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 1:80 EAST 11TH STREET
Mailing Address - Street 2:SUITE 618
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-533-2130
Mailing Address - Fax:
Practice Address - Street 1:80 EAST 11TH STREET
Practice Address - Street 2:SUITE 618
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-533-2130
Practice Address - Fax:212-533-2130
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0692821041C0700X
NY73-0692821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical