Healthcare Provider Details

I. General information

NPI: 1265353163
Provider Name (Legal Business Name): COURTNEY ADISANO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 AUSTIN ST STE 200
FOREST HILLS NY
11375-4739
US

IV. Provider business mailing address

413 KISSEL AVE
STATEN ISLAND NY
10301-2600
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-7633
  • Fax: 718-886-8694
Mailing address:
  • Phone: 718-873-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: