MEDICARE: DR. ANA CARRION PHD, LCSW-R

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	1041C0700X	Clinical Social Worker	R-051132-1	NY
2	1041S0200X	School Social Worker	890020991	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558507053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANA CARRION PHD, LCSW-R

Provider Business Mailing Address
First Line	:	14 WASHINGTON AVE
Second Line	:	SUITE 2
City	:	BRENTWOOD
State	:	NY
Zip	:	11717-3247
Country	:	US
Telephone Number	:	631-617-5300
Fax Number	:	888-272-0686

Provider Business Practice Location Address
First Line	:	14 WASHINGTON AVE
Second Line	:	SUITE 2
City	:	BRENTWOOD
State	:	NY
Zip	:	11717-3247
Country	:	US
Telephone Number	:	631-617-5300
Fax Number	:	888-272-0686

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

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	03/02/2015

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