Provider Demographics
NPI:1912067240
Name:DEGAETANO, DEANNA (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:
Last Name:DEGAETANO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 TERRACE PL
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-4146
Mailing Address - Country:US
Mailing Address - Phone:914-793-7966
Mailing Address - Fax:
Practice Address - Street 1:90 BRYANT AVE
Practice Address - Street 2:SUITE TD
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1952
Practice Address - Country:US
Practice Address - Phone:914-428-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR031579-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN98501Medicare ID - Type Unspecified