Provider Demographics
NPI:1669489456
Name:CARRION, YOLANDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:
Last Name:CARRION
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 ATLANTIC AVE
Mailing Address - Street 2:4A
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5256
Mailing Address - Country:US
Mailing Address - Phone:516-378-5059
Mailing Address - Fax:516-546-5051
Practice Address - Street 1:429 ATLANTIC AVE
Practice Address - Street 2:4A
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5256
Practice Address - Country:US
Practice Address - Phone:516-378-5059
Practice Address - Fax:516-546-5051
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027743-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02026117Medicaid
NY02026117Medicaid
NYN88431Medicare UPIN