Provider Demographics
NPI:1518324045
Name:CARACCIOLO, ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:CARACCIOLO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BELLROSE RD
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-1320
Mailing Address - Country:US
Mailing Address - Phone:631-897-0770
Mailing Address - Fax:
Practice Address - Street 1:408 MAIN STREET SOUTH
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-1320
Practice Address - Country:US
Practice Address - Phone:631-874-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0717601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical