Provider Demographics
NPI:1578441028
Name:THE IDENTITY SPACE LCSW, PLLC
Entity type:Organization
Organization Name:THE IDENTITY SPACE LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALIPERTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-369-4676
Mailing Address - Street 1:244 MADISON AVENUE
Mailing Address - Street 2:FRONT 4 #360
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:244 MADISON AVENUE
Practice Address - Street 2:FRONT 4 #360
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:347-369-4676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty