Provider Demographics
NPI:1083324560
Name:CARINI, COLLEEN P (LMSW)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:P
Last Name:CARINI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 PLEASURE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-4921
Mailing Address - Country:US
Mailing Address - Phone:631-494-8406
Mailing Address - Fax:
Practice Address - Street 1:579 PLEASURE DR
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-4921
Practice Address - Country:US
Practice Address - Phone:631-494-8406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099169-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty