Healthcare Provider Details

I. General information

NPI: 1669795266
Provider Name (Legal Business Name): ANGELO SACCO L.C.S.W-R
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD SUITE 205
PLAINVIEW NY
11803-1311
US

IV. Provider business mailing address

1209 116TH ST
COLLEGE POINT NY
11356-1540
US

V. Phone/Fax

Practice location:
  • Phone: 516-458-8900
  • Fax:
Mailing address:
  • Phone: 516-458-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR070112-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: