Provider Demographics
NPI:1932335494
Name:DENICOLO, EILEEN TERESA (LCSW)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:TERESA
Last Name:DENICOLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:TERESA
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:P.O. BOX 330
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:516-698-5511
Mailing Address - Fax:516-418-5377
Practice Address - Street 1:10 TYBURN LANE
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720
Practice Address - Country:US
Practice Address - Phone:516-698-5511
Practice Address - Fax:516-418-5377
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0844161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical