Provider Demographics
NPI:1447452792
Name:PETROCELLI, ANN MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:PETROCELLI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 SHORE RD
Mailing Address - Street 2:APT 338
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4254
Mailing Address - Country:US
Mailing Address - Phone:347-853-0598
Mailing Address - Fax:
Practice Address - Street 1:8701 SHORE RD
Practice Address - Street 2:APT 338
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4254
Practice Address - Country:US
Practice Address - Phone:347-853-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0747271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical