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General NPI Number Information
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NPI Number | 1659678472
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Entity Type | Individual
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Provider Name | ANTHONY THOMAS PROCACCINO JR. PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 1 DONAHUE AVE. NUMBER TWO ELEMENTARY SCHOOL LAWRENCE PUBLIC SCHOOLS
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City | INWOOD
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State | NY
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Zip | 11096
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Country | US
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Telephone | 516-295-6212
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Fax | 516-295-6213
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Provider Business Mailing Address
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Address Line | 1 DONAHUE AVE. NUMBER TWO ELEMENTARY SCHOOL LAWRENCE PUBLIC SCHOOLS
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City | INWOOD
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State | NY
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Zip | 11096
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Country | US
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Telephone | 516-295-6212
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Fax | 516-295-6213
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 014013
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License Number State | NY
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