Healthcare Provider Details

I. General information

NPI: 1801950456
Provider Name (Legal Business Name): CARLE B MAIZNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 COMMACK RD SUITE #1
COMMACK NY
11725-5401
US

IV. Provider business mailing address

21 ARCADIA DR
DIX HILLS NY
11746-6935
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-4542
  • Fax: 631-475-5470
Mailing address:
  • Phone: 631-475-4542
  • Fax: 631-475-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR031122-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: