Provider Demographics
NPI:1306267968
Name:ALICIA DELLAGIOVANNA LCSW PC
Entity type:Organization
Organization Name:ALICIA DELLAGIOVANNA LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLAGIOVANNA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-964-7362
Mailing Address - Street 1:31 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1325
Mailing Address - Country:US
Mailing Address - Phone:718-964-7362
Mailing Address - Fax:516-773-3695
Practice Address - Street 1:11045 71ST RD
Practice Address - Street 2:SUITE 1G
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4960
Practice Address - Country:US
Practice Address - Phone:718-964-7362
Practice Address - Fax:516-773-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0756771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty