Provider Demographics
NPI:1669741153
Name:PUGLIESE, ANTHONY (LCSW)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PUGLIESE
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 1:777 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3405
Mailing Address - Country:US
Mailing Address - Phone:718-351-5530
Mailing Address - Fax:718-351-5639
Practice Address - Street 1:777 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3405
Practice Address - Country:US
Practice Address - Phone:718-351-5530
Practice Address - Fax:718-351-5639
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13-4182492Medicaid