Healthcare Provider Details

I. General information

NPI: 1457428534
Provider Name (Legal Business Name): MERRILL TOMLINSON-CARINCI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 233RD ST
BELLEROSE MANOR NY
11427-2111
US

IV. Provider business mailing address

80-19 233RD STREET
BELLEROSE MANOR NY
11427
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-0915
  • Fax: 718-264-0915
Mailing address:
  • Phone: 718-264-0915
  • Fax: 718-264-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR047896-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: