Provider Demographics
NPI:1659466670
Name:CARRION, WAYNE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:CARRION
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 1:420 E 23RD ST
Mailing Address - Street 2:6C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5033
Mailing Address - Country:US
Mailing Address - Phone:212-460-9344
Mailing Address - Fax:212-260-7037
Practice Address - Street 1:333 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5947
Practice Address - Country:US
Practice Address - Phone:718-339-5300
Practice Address - Fax:718-339-9082
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR024173-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWC0N8K5210Medicare ID - Type Unspecified