Provider Demographics
NPI:1780627851
Name:PRESTIGIACOMO, PATRICIA ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:PRESTIGIACOMO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:ROMO-MACALUSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:850 MILL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1463
Mailing Address - Country:US
Mailing Address - Phone:775-538-6700
Mailing Address - Fax:775-688-5878
Practice Address - Street 1:850 MILL ST STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1463
Practice Address - Country:US
Practice Address - Phone:775-538-6700
Practice Address - Fax:775-688-5678
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4402-S104100000X
NVIC-4101041C0700X
NV5133-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507630Medicaid