Basic Information
| Provider Information | |||||||||
| NPI: | 1497796825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASSARO | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 GRAMATAN AVE | ||||||||
| Address2: | APT 2 -F | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105521840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146651218 | ||||||||
| FaxNumber: | 9142350822 | ||||||||
| Practice Location | |||||||||
| Address1: | 481 MAIN ST | ||||||||
| Address2: | SUITE 403-A | ||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108016324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149124859 | ||||||||
| FaxNumber: | 9142350822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 5343343 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.