Healthcare Provider Details

I. General information

NPI: 1326284407
Provider Name (Legal Business Name): PENNY ANN YETTO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. PENNY ANN RIZZUTO

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S PEARL ST
ALBANY NY
12202-1809
US

IV. Provider business mailing address

260 S PEARL ST
ALBANY NY
12202-1809
US

V. Phone/Fax

Practice location:
  • Phone: 518-447-4555
  • Fax: 518-447-4661
Mailing address:
  • Phone: 518-447-4555
  • Fax: 518-447-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number071871-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: