Provider Demographics
NPI:1154430320
Name:RACANELLI, B JOY (LCSW)
Entity type:Individual
Prefix:
First Name:B JOY
Middle Name:
Last Name:RACANELLI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MORRIS LN
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-3404
Mailing Address - Country:US
Mailing Address - Phone:516-922-7609
Mailing Address - Fax:516-922-9482
Practice Address - Street 1:4 MORRIS LN
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-3404
Practice Address - Country:US
Practice Address - Phone:516-922-7609
Practice Address - Fax:516-922-9482
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR 025186-11041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN97621Medicare UPIN