Provider Demographics
NPI:1336485200
Name:CARABALLO, REMIL ANTONIO (CASAC-T)
Entity Type:Individual
Prefix:MR
First Name:REMIL
Middle Name:ANTONIO
Last Name:CARABALLO
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 8TH AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-3426
Mailing Address - Country:US
Mailing Address - Phone:212-365-4569
Mailing Address - Fax:
Practice Address - Street 1:2090 7TH AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4990
Practice Address - Country:US
Practice Address - Phone:718-772-0201
Practice Address - Fax:718-772-0260
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27615101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)