Provider Demographics
NPI:1255053690
Name:SOBOTA, CAROLINE HELENE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:HELENE
Last Name:SOBOTA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CAROLINE
Other - Middle Name:HELENE
Other - Last Name:DOOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:271 WALDEN CT
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-1824
Mailing Address - Country:US
Mailing Address - Phone:631-801-2488
Mailing Address - Fax:
Practice Address - Street 1:440 FURROWS RD
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2700
Practice Address - Country:US
Practice Address - Phone:631-645-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker