Provider Demographics
NPI:1033873906
Name:JACQUELYN CARRANO, LCSW LLC
Entity Type:Organization
Organization Name:JACQUELYN CARRANO, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CARRANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-444-0412
Mailing Address - Street 1:273 DERBY AVE UNIT 511
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2086
Mailing Address - Country:US
Mailing Address - Phone:203-444-0412
Mailing Address - Fax:
Practice Address - Street 1:273 DERBY AVE UNIT 511
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-2086
Practice Address - Country:US
Practice Address - Phone:203-444-0412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty