Provider Demographics
NPI:1477823847
Name:CARRILLO-ENCARNACION, MADELINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:CARRILLO-ENCARNACION
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 W 180TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-5849
Mailing Address - Country:US
Mailing Address - Phone:212-795-9888
Mailing Address - Fax:212-795-9899
Practice Address - Street 1:549 W 180TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5849
Practice Address - Country:US
Practice Address - Phone:212-795-9888
Practice Address - Fax:212-795-9899
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073056-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical