Provider Demographics
NPI:1801613369
Name:IACONELLI, ANDERS P (LMSW)
Entity type:Individual
Prefix:
First Name:ANDERS
Middle Name:P
Last Name:IACONELLI
Suffix:
Gender:X
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PEYSTER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-2527
Mailing Address - Country:US
Mailing Address - Phone:845-514-4150
Mailing Address - Fax:
Practice Address - Street 1:10 COLVIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1242
Practice Address - Country:US
Practice Address - Phone:518-801-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125122-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker