Healthcare Provider Details

I. General information

NPI: 1992853568
Provider Name (Legal Business Name): GLORIA R CIOLLI LMSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 PINETREE LN
ROSLYN HEIGHTS NY
11577-2421
US

IV. Provider business mailing address

119 PINETREE LN
ROSLYN HEIGHTS NY
11577-2421
US

V. Phone/Fax

Practice location:
  • Phone: 516-484-0303
  • Fax: 516-484-5028
Mailing address:
  • Phone: 516-484-0303
  • Fax: 516-484-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number043410-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: