Basic Information
| Provider Information | |||||||||
| NPI: | 1871841577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARUSO | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | SEBASTIAN | ||||||||
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| Credential: | MSW, LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 GREENE DRIVE | ||||||||
| Address2: | |||||||||
| City: | COMMACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317478121 | ||||||||
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| Practice Location | |||||||||
| Address1: | 175 FULTON AVE | ||||||||
| Address2: | |||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164855710 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2012 | ||||||||
| LastUpdateDate: | 08/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 086771-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.