Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | R077876-1 | NY |
NPI | 1003219239 |
---|---|
Provider Name | Mrs. Lisa Vitucci |
First Address | New Hyde Park, NY 11042-1113 |
Second Address | New Hyde Park, NY 11042-1113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2014 |
Last Update Date | 12/10/2016 |