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General NPI Number Information
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NPI Number | 1306267968
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Entity Type | Organization
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Legal Business Name | ALICIA DELLAGIOVANNA LCSW PC
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Dates
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Enumeration Date | 12/30/2013
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 11045 71ST RD SUITE 1G
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City | FOREST HILLS
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State | NY
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Zip | 11375-4960
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Country | US
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Telephone | 718-964-7362
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Fax | 516-773-3695
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Provider Business Mailing Address
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Address Line | 31 KNOLLWOOD RD
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City | ROSLYN
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State | NY
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Zip | 11576-1325
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Country | US
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Telephone | 718-964-7362
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Fax | 516-773-3695
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALICIA DELLAGIOVANNA
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Credential | LCSW
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Telephone | 718-964-7362
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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 | 075677
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License Number State | NY
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