Healthcare Provider Details

I. General information

NPI: 1437214798
Provider Name (Legal Business Name): LORRAINE CECILIA PETRUCCI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 ATLANTIC AVE
BROOKLYN NY
11213-1122
US

IV. Provider business mailing address

326 W 83RD ST APT 6D
NEW YORK NY
10024-4813
US

V. Phone/Fax

Practice location:
  • Phone: 718-613-4488
  • Fax: 718-613-4381
Mailing address:
  • Phone: 212-595-5723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number054597-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: