Healthcare Provider Details

I. General information

NPI: 1114472248
Provider Name (Legal Business Name): ELIZABETH CARRASQUILLO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 JEFFERSON ST SUITE 1
MONTICELLO NY
12701-1148
US

IV. Provider business mailing address

64 JEFFERSON ST SUITE 1
MONTICELLO NY
12701-1148
US

V. Phone/Fax

Practice location:
  • Phone: 845-791-8800
  • Fax: 845-791-7051
Mailing address:
  • Phone: 845-791-8800
  • Fax: 845-791-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number094697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: