Provider Demographics
NPI:1104165448
Name:PIZZO, JESSICA (MSW STUDENT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PIZZO
Suffix:
Gender:F
Credentials:MSW STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LAFAYETTE AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1020
Mailing Address - Country:US
Mailing Address - Phone:718-475-9417
Mailing Address - Fax:718-483-9287
Practice Address - Street 1:600 LAFAYETTE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1020
Practice Address - Country:US
Practice Address - Phone:718-475-9417
Practice Address - Fax:718-483-9287
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03505424Medicaid