Provider Demographics
NPI:1356381743
Name:TAIBI, CARRIE (LCSW-R)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:TAIBI
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COLERIDGE PL
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-2601
Mailing Address - Country:US
Mailing Address - Phone:631-239-5447
Mailing Address - Fax:
Practice Address - Street 1:260 W MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8322
Practice Address - Country:US
Practice Address - Phone:631-647-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073253-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02135326Medicaid
NYNS5411Medicare ID - Type UnspecifiedEMPIRE MEDICARE