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General NPI Number Information
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NPI Number | 1871841577
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Entity Type | Individual
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Provider Name | DEREK S. CARUSO MSW, MSN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 28 BOX ST APT N219
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City | BROOKLYN
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State | NY
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Zip | 11222-5585
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Country | US
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Telephone | 929-683-3320
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Fax | 866-275-8660
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Provider Business Mailing Address
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Address Line | 16 WILLIAMS BLVD APT 1D
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City | LAKE GROVE
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State | NY
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Zip | 11755-2413
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Country | US
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Telephone | 631-747-8121
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Fax | 866-275-8660
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 084067
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 086771
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 744382
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F405069
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License Number State | NY
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