Provider Demographics
NPI:1891947271
Name:CARBALLEIRA, CATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CARBALLEIRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:CARBALLEIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RCSW
Mailing Address - Street 1:112 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1217
Mailing Address - Country:US
Mailing Address - Phone:516-374-3671
Mailing Address - Fax:516-374-7864
Practice Address - Street 1:112 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1217
Practice Address - Country:US
Practice Address - Phone:516-374-3671
Practice Address - Fax:516-374-7864
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16785101YA0400X
NY073124-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)