Provider Demographics
NPI:1275835704
Name:EDEN, CARL (R-LCSW)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:EDEN
Suffix:
Gender:M
Credentials:R-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:VILLAGE STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-0305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3441 78TH ST
Practice Address - Street 2:1-I
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-2571
Practice Address - Country:US
Practice Address - Phone:718-898-8918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-05
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO33051-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical