Provider Demographics
NPI:1710188594
Name:SIDOTI, ANTHONY LAWRENCE (LCSW)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LAWRENCE
Last Name:SIDOTI
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 1:77 SEVENTH AVENUE
Mailing Address - Street 2:APARTMENT 15V
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-989-1478
Mailing Address - Fax:
Practice Address - Street 1:817 BROADWAY
Practice Address - Street 2:NORTH SUITE ROOM 9
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-645-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0312371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR031237OtherEDUCATION DEPARTMENT DIVI
NYR031237OtherEDUCATION DEPARTMENT DIVI