Provider Demographics
NPI:1396951109
Name:INFANTE, LOUIS RAPHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:RAPHAEL
Last Name:INFANTE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:LOUIS
Other - Middle Name:RAPHAEL
Other - Last Name:INFANTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:159 SHERADEN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4331
Mailing Address - Country:US
Mailing Address - Phone:718-983-5893
Mailing Address - Fax:718-983-5893
Practice Address - Street 1:159 SHERADEN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4331
Practice Address - Country:US
Practice Address - Phone:718-983-5893
Practice Address - Fax:718-983-5893
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR030879-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical