Provider Demographics
NPI:1114472248
Name:CARRASQUILLO, ELIZABETH (LMSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CARRASQUILLO
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 1:64 JEFFERSON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1148
Mailing Address - Country:US
Mailing Address - Phone:845-791-8800
Mailing Address - Fax:845-791-7051
Practice Address - Street 1:64 JEFFERSON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1148
Practice Address - Country:US
Practice Address - Phone:845-791-8800
Practice Address - Fax:845-791-7051
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094697104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker