Provider Demographics
NPI:1902051865
Name:CAVALLETTO, NATHANIEL RYAN (LCSW)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:RYAN
Last Name:CAVALLETTO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 LEFFERTS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3901
Mailing Address - Country:US
Mailing Address - Phone:917-326-0253
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:SUITE 2204
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-0103
Practice Address - Country:US
Practice Address - Phone:917-326-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081103-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical