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NPI Code Detail

MEDICARE: CARLA CARLYON LCSWR

MEDICARE: CARLA CARLYON LCSWR
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
11041C0700XClinical Social Worker042443NY

General Provider Information

NPI Number : 1356410807
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLA CARLYON LCSWR
Provider Business Mailing Address
First Line : 43 OCEAN AVE
Second Line :
City : NORTHPORT
State : NY
Zip : 11768-1810
Country : US
Telephone Number : 631-807-4311
Fax Number :
Provider Business Practice Location Address
First Line : 151 BURRS LN
Second Line :
City : DIX HILLS
State : NY
Zip : 11746-6052
Country : US
Telephone Number : 631-643-8800
Fax Number : 631-491-4440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 02/14/2022

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Directions to “ CARLA CARLYON LCSWR” Practice Location

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