Provider Demographics
NPI:1558507053
Name:CARRION, ANA (PHD, LCSW-R)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:
Last Name:CARRION
Suffix:
Gender:F
Credentials:PHD, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WASHINGTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-3247
Mailing Address - Country:US
Mailing Address - Phone:631-617-5300
Mailing Address - Fax:888-272-0686
Practice Address - Street 1:14 WASHINGTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-3247
Practice Address - Country:US
Practice Address - Phone:631-617-5300
Practice Address - Fax:888-272-0686
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-051132-11041C0700X
NY8900209911041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03345677Medicaid
NY03345677Medicaid