Healthcare Provider Details

I. General information

NPI: 1073449070
Provider Name (Legal Business Name): MR. JULIO CESAR R CARACCIOLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 NORTHERN BLVD STE 200
LONG ISLAND CITY NY
11101-2809
US

IV. Provider business mailing address

3030 NORTHERN BLVD STE 200
LONG ISLAND CITY NY
11101-2809
US

V. Phone/Fax

Practice location:
  • Phone: 646-730-5026
  • Fax:
Mailing address:
  • Phone: 646-730-5026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number117174-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: