Healthcare Provider Details

I. General information

NPI: 1497121271
Provider Name (Legal Business Name): NUNZIO SIGNORELLA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E. 11TH STREET 610
NEW YORK NY
10003-6819
US

IV. Provider business mailing address

159 MADISON AVE, 3I
NEW YORK NY
10016-5434
US

V. Phone/Fax

Practice location:
  • Phone: 347-675-9873
  • Fax: 646-707-0109
Mailing address:
  • Phone: 347-675-9873
  • Fax: 646-707-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. NUNZIO SIGNORELLA
Title or Position: PRINCIPAL
Credential: LCSW
Phone: 347-675-9873