Provider Demographics
NPI:1881716231
Name:ZANETTI, CARL THOMAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:THOMAS
Last Name:ZANETTI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2121
Mailing Address - Country:US
Mailing Address - Phone:516-249-8629
Mailing Address - Fax:516-249-7321
Practice Address - Street 1:15 HAMPSHIRE DR
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2121
Practice Address - Country:US
Practice Address - Phone:516-249-8629
Practice Address - Fax:516-249-7321
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0557531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN5J291Medicare ID - Type Unspecified
NYN5J292Medicare UPIN