Provider Demographics
NPI:1649030180
Name:PATITUCCI, ELISA (LMSW)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:PATITUCCI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MANSFIELD PL
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-4030
Mailing Address - Country:US
Mailing Address - Phone:516-417-1426
Mailing Address - Fax:
Practice Address - Street 1:5928 LITTLE NECK PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2532
Practice Address - Country:US
Practice Address - Phone:718-224-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119756104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker