Provider Demographics
NPI:1619492527
Name:HEADLEY, KARINA VIVIANA (LMSW)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:VIVIANA
Last Name:HEADLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KARINA
Other - Middle Name:VIVIANA
Other - Last Name:CABRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:465 MERRICK RD APT 2W
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5466
Mailing Address - Country:US
Mailing Address - Phone:516-244-9859
Mailing Address - Fax:
Practice Address - Street 1:6120 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3577
Practice Address - Country:US
Practice Address - Phone:718-672-1705
Practice Address - Fax:718-672-2027
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100532-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical