Provider Demographics
NPI:1659593374
Name:CARNESECCHI, JOHN P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:CARNESECCHI
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 1:111 BROADWAY
Mailing Address - Street 2:9TH FLOOR, SUITE #905
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006
Mailing Address - Country:US
Mailing Address - Phone:646-494-6732
Mailing Address - Fax:
Practice Address - Street 1:111 BROADWAY
Practice Address - Street 2:9TH FLOOR, SUITE #905
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006
Practice Address - Country:US
Practice Address - Phone:917-757-1715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07002311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN576L1Medicare ID - Type Unspecified