Provider Demographics
NPI:1053598102
Name:PALISI-BASTONE, ANNA (LCSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PALISI-BASTONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ENDICOTT LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4006
Mailing Address - Country:US
Mailing Address - Phone:631-838-9151
Mailing Address - Fax:
Practice Address - Street 1:4 ENDICOTT LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4006
Practice Address - Country:US
Practice Address - Phone:631-838-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07335311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical