Provider Demographics
NPI:1871841577
Name:CARUSO, DEREK (MSN, PMHNP-BC, APRN)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:CARUSO
Suffix:
Gender:M
Credentials:MSN, PMHNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BOX ST APT N219
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-5585
Mailing Address - Country:US
Mailing Address - Phone:631-747-8121
Mailing Address - Fax:
Practice Address - Street 1:623 STEWART AVE STE 203
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4771
Practice Address - Country:US
Practice Address - Phone:631-673-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086771-1104100000X
NYF405069363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker