Provider Demographics
NPI:1386317501
Name:CARRILLO-ERAZO, LORRAINE (HHA)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:
Last Name:CARRILLO-ERAZO
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6339
Mailing Address - Country:US
Mailing Address - Phone:718-942-5312
Mailing Address - Fax:
Practice Address - Street 1:1581 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6339
Practice Address - Country:US
Practice Address - Phone:718-942-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01084066374U00000X
NY00885458374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty