Provider Demographics
NPI:1174275069
Name:CARAVEO, KATELYN ANNE (MA, MHC-LP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:ANNE
Last Name:CARAVEO
Suffix:
Gender:F
Credentials:MA, MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LINCOLN AVE
Mailing Address - Street 2:APT 23C
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:401-297-7536
Mailing Address - Fax:
Practice Address - Street 1:649 COMMACK ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1172
Practice Address - Country:US
Practice Address - Phone:631-493-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP112804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP112804OtherPRIVATE PRACTICE