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General NPI Number Information
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NPI Number | 1003144007
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Entity Type | Individual
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Provider Name | CARLY LOONIE LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/02/2009
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 13002 115TH AVE
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420-2122
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Country | US
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Telephone | 718-641-8933
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Fax | 718-641-8931
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Provider Business Mailing Address
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Address Line | 27385 SPRUCE LN
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City | EVERGREEN
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State | CO
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Zip | 80439-5475
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Country | US
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Telephone | 516-220-0133
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 079824
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0804681
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License Number State | NY
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