Provider Demographics
NPI:1215485958
Name:CARILLO, KIRSTEN (LMSW)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:CARILLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CAROLYN WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-2622
Mailing Address - Country:US
Mailing Address - Phone:917-602-7001
Mailing Address - Fax:
Practice Address - Street 1:10 EDUCATION DR
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-4066
Practice Address - Country:US
Practice Address - Phone:845-838-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057255-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical