Provider Demographics
NPI:1598849101
Name:ANGRISANI, CARMINE J (CSW)
Entity Type:Individual
Prefix:MR
First Name:CARMINE
Middle Name:J
Last Name:ANGRISANI
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 HALLOCK AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-928-2825
Mailing Address - Fax:631-476-0766
Practice Address - Street 1:1050 HALLOCK AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-928-2825
Practice Address - Fax:631-476-0766
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO13187-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN17341Medicare PIN