Provider Demographics
NPI:1891457073
Name:CARRASQUILLO, HAYDEE (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:HAYDEE
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OLD HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7250
Mailing Address - Country:US
Mailing Address - Phone:929-331-9668
Mailing Address - Fax:
Practice Address - Street 1:12 OLD HEMLOCK DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7250
Practice Address - Country:US
Practice Address - Phone:929-331-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 172V00000X, 174H00000X, 175L00000X, 374J00000X, 390200000X
NY101YS0200X, 171M00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No175L00000XOther Service ProvidersHomeopath
No374J00000XNursing Service Related ProvidersDoula
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program