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General NPI Number Information
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NPI Number | 1265973960
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Entity Type | Organization
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Legal Business Name | ELIZABETH CIANCHETTI, LCSW, PLLC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 1218 -12TH ST.
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City | WEST BABYLON
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State | NY
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Zip | 11704
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Country | US
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Telephone | 631-835-9631
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Fax | 631-592-2816
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Provider Business Mailing Address
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Address Line | 654 NORTH WELLWOOD AVE SUITE # D-297
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City | LINDENHURST
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State | NY
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Zip | 11704
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Country | US
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Telephone | 631-835-9631
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Fax | 631-592-2816
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Authorized Official
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Title or Position | CEO
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Name | MS. ELIZABETH CIANCHETTI
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Credential | LCSW
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Telephone | 631-835-9631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R076342
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License Number State | NY
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