Provider Demographics
NPI:1730050436
Name:STALEY, KARAZIN RAMARA (LMSW)
Entity type:Individual
Prefix:
First Name:KARAZIN
Middle Name:RAMARA
Last Name:STALEY
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 1:15 ATLANTIC AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3051
Mailing Address - Country:US
Mailing Address - Phone:516-884-9977
Mailing Address - Fax:
Practice Address - Street 1:15 ATLANTIC AVE STE 110
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3051
Practice Address - Country:US
Practice Address - Phone:516-884-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128690-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health