MEDICARE: MR. CARLOS ALBERTO CAMPETTA MSW, 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	077218	NY

General Provider Information

NPI Number	:	1871674283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLOS ALBERTO CAMPETTA MSW, LCSW-R

Provider Business Mailing Address
First Line	:	175 W 93RD ST APT 6J
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-9326
Country	:	US
Telephone Number	:	917-287-8164
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 W 35TH ST FL 7
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-1904
Country	:	US
Telephone Number	:	917-287-8164
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	02/02/2025

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