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General NPI Number Information
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NPI Number | 1669620670
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Entity Type | Individual
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Provider Name | CESAR CARRASCO LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 635 W 165TH ST FL 6
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City | NEW YORK
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State | NY
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Zip | 10032-3724
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Country | US
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Telephone | 212-305-6506
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Fax |
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Provider Business Mailing Address
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Address Line | 60 BROAD ST W APT 5A
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City | MOUNT VERNON
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State | NY
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Zip | 10552-2139
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Country | US
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Telephone | 212-545-9664
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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 | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 081452
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License Number State | NY
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