Provider Demographics
NPI:1508890906
Name:DISALVO, CAROLE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:DISALVO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11408 WORCESTER RUN
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6223
Mailing Address - Country:US
Mailing Address - Phone:239-292-1962
Mailing Address - Fax:
Practice Address - Street 1:11408 WORCESTER RUN
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6223
Practice Address - Country:US
Practice Address - Phone:239-292-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW80601041C0700X
NYR037622-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN6B231Medicare ID - Type Unspecified