Healthcare Provider Details

I. General information

NPI: 1679769251
Provider Name (Legal Business Name): CARRIE ANN SABATO BRILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W HAWTHORNE AVE
VALLEY STREAM NY
11580-6220
US

IV. Provider business mailing address

50 W HAWTHORNE AVE
VALLEY STREAM NY
11580-6220
US

V. Phone/Fax

Practice location:
  • Phone: 516-569-6600
  • Fax: 516-374-2261
Mailing address:
  • Phone: 516-569-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077660
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: