Provider Demographics
NPI:1912779349
Name:YACCARINO, COLIN HENRY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:HENRY
Last Name:YACCARINO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1551
Mailing Address - Country:US
Mailing Address - Phone:631-335-3315
Mailing Address - Fax:
Practice Address - Street 1:58 KNOLLWOOD RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1551
Practice Address - Country:US
Practice Address - Phone:631-335-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker