Provider Demographics
NPI:1457428534
Name:TOMLINSON-CARINCI, MERRILL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MERRILL
Middle Name:
Last Name:TOMLINSON-CARINCI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80-19 233RD STREET
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11427
Mailing Address - Country:US
Mailing Address - Phone:718-264-0915
Mailing Address - Fax:718-264-0915
Practice Address - Street 1:8019 233RD ST
Practice Address - Street 2:
Practice Address - City:BELLEROSE MANOR
Practice Address - State:NY
Practice Address - Zip Code:11427-2111
Practice Address - Country:US
Practice Address - Phone:718-264-0915
Practice Address - Fax:718-264-0915
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047896-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP90035Medicare UPIN
NY05770Medicare ID - Type UnspecifiedPROVIDER #