Healthcare Provider Details

I. General information

NPI: 1871841577
Provider Name (Legal Business Name): DEREK S. CARUSO MSW, MSN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 BOX ST APT N219
BROOKLYN NY
11222-5585
US

IV. Provider business mailing address

28 BOX ST APT N219
BROOKLYN NY
11222-5585
US

V. Phone/Fax

Practice location:
  • Phone: 929-683-3320
  • Fax: 866-275-8660
Mailing address:
  • Phone: 631-747-8121
  • Fax: 866-275-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number744382
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF405069
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084067
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number086771
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number744382
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: