Provider Demographics
NPI:1669706396
Name:PANTALEONI, RICHARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:PANTALEONI
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 1:15934 RIVERSIDE DR W
Mailing Address - Street 2:APT 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1014
Mailing Address - Country:US
Mailing Address - Phone:203-240-4180
Mailing Address - Fax:
Practice Address - Street 1:51 E 42ND ST
Practice Address - Street 2:SUITE 820
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5404
Practice Address - Country:US
Practice Address - Phone:203-240-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081140-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY081140-1OtherNEW YORK STATE LICENSED CLINICAL SOCIAL WORKER LICENSE