Provider Demographics
NPI:1265973960
Name:ELIZABETH CIANCHETTI, LCSW, PLLC
Entity type:Organization
Organization Name:ELIZABETH CIANCHETTI, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CIANCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-835-9631
Mailing Address - Street 1:654 NORTH WELLWOOD AVE
Mailing Address - Street 2:SUITE # D-297
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11704
Mailing Address - Country:US
Mailing Address - Phone:631-835-9631
Mailing Address - Fax:631-592-2816
Practice Address - Street 1:1218 -12TH ST.
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704
Practice Address - Country:US
Practice Address - Phone:631-835-9631
Practice Address - Fax:631-592-2816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0763421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty