Healthcare Provider Details

I. General information

NPI: 1255401626
Provider Name (Legal Business Name): CAROL ANNE PICANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BAYVILLE AVE
BAYVILLE NY
11709
US

IV. Provider business mailing address

35 CHERYL RD
MASSAPEQUA NY
11758
US

V. Phone/Fax

Practice location:
  • Phone: 516-628-3500
  • Fax:
Mailing address:
  • Phone: 516-579-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number058224-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: