Provider Demographics
NPI:1316140528
Name:PIRRO, JUDITH L (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:PIRRO
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 1:716 WASHINGTON STREET
Mailing Address - Street 2:#1
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-786-2877
Mailing Address - Fax:315-786-9960
Practice Address - Street 1:716 WASHINGTON STREET
Practice Address - Street 2:#1
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-786-2877
Practice Address - Fax:315-786-9960
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0451851104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB5105Medicare ID - Type Unspecified