Provider Demographics
NPI:1205168010
Name:INGENITO, PAUL V (LMSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:V
Last Name:INGENITO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4349 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6501
Mailing Address - Country:US
Mailing Address - Phone:718-317-5522
Mailing Address - Fax:347-825-2332
Practice Address - Street 1:4349 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-317-5522
Practice Address - Fax:347-825-2332
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071857104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker