Provider Demographics
NPI:1811053770
Name:CAVALENES JOYCE, ANTOINETTE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:
Last Name:CAVALENES JOYCE
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 1:290 GARRETSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1236
Mailing Address - Country:US
Mailing Address - Phone:718-698-3222
Mailing Address - Fax:
Practice Address - Street 1:290 GARRETSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1236
Practice Address - Country:US
Practice Address - Phone:718-698-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0361091041C0700X
NJSC043021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY053476000Medicare UPIN
NYN76411Medicare ID - Type Unspecified
NY5623681Medicare UPIN
NY1P302810Medicare UPIN
NY254974Medicare UPIN
NYGHIMedicare UPIN
NY108633Medicare UPIN
NY23694Medicare UPIN
NY7483237Medicare UPIN