MEDICARE: JENNIFER CARBAJAL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	099612	NY
2	1041C0700X	Clinical Social Worker	093059	NY

General Provider Information

NPI Number	:	1215461470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CARBAJAL LCSW

Provider Business Mailing Address
First Line	:	330 E BROADWAY APT 202
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10101 ROCKAWAY BLVD
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11417-2228
Country	:	US
Telephone Number	:	516-853-8898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2017
Last Update Date	:	09/15/2022

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Directions to “ JENNIFER CARBAJAL LCSW” Practice Location

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