=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558507053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANA CARRION PHD, LCSW-R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2009
-----------------------------------------------------
Last Update Date | 03/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 WASHINGTON AVE SUITE 2
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11717-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-617-5300
-----------------------------------------------------
Fax | 888-272-0686
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 WASHINGTON AVE SUITE 2
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11717-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-617-5300
-----------------------------------------------------
Fax | 888-272-0686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R-051132-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number | 890020991
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------