Provider Demographics
NPI:1366743015
Name:CARNAZZA, CLEMENTINA MARIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CLEMENTINA
Middle Name:MARIA
Last Name:CARNAZZA
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 1:222 HARRISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558
Mailing Address - Country:US
Mailing Address - Phone:516-897-1915
Mailing Address - Fax:
Practice Address - Street 1:222 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1310
Practice Address - Country:US
Practice Address - Phone:516-897-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0575431104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker