Provider Demographics
NPI:1740748052
Name:TRUJILLO, CARLI DARLENE (MSW)
Entity Type:Individual
Prefix:
First Name:CARLI
Middle Name:DARLENE
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 E 12TH ST APT MW
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-1287
Mailing Address - Country:US
Mailing Address - Phone:385-900-9123
Mailing Address - Fax:
Practice Address - Street 1:50 COURT ST FL 9
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4825
Practice Address - Country:US
Practice Address - Phone:347-328-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1231002011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty