Provider Demographics
NPI:1740276849
Name:LERRO, ANTHONY VINCENT (LCSW)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:VINCENT
Last Name:LERRO
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 1:1971 DE KALB AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2602
Mailing Address - Country:US
Mailing Address - Phone:516-379-0525
Mailing Address - Fax:516-379-2772
Practice Address - Street 1:1971 DE KALB AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2602
Practice Address - Country:US
Practice Address - Phone:516-379-0525
Practice Address - Fax:516-379-2772
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO16844-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNO5241Medicare ID - Type Unspecified