Provider Demographics
NPI:1427330471
Name:SCOGNAMILLO, GAETANO
Entity type:Individual
Prefix:
First Name:GAETANO
Middle Name:
Last Name:SCOGNAMILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 81ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5833
Mailing Address - Country:US
Mailing Address - Phone:212-989-2990
Mailing Address - Fax:212-792-6058
Practice Address - Street 1:200 W 81ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5833
Practice Address - Country:US
Practice Address - Phone:212-989-2990
Practice Address - Fax:212-792-6058
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA712531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health