Provider Demographics
NPI:1962730093
Name:CUVILLY, CARINE A (LCSW - R)
Entity type:Individual
Prefix:MISS
First Name:CARINE
Middle Name:A
Last Name:CUVILLY
Suffix:
Gender:F
Credentials:LCSW - R
Other - Prefix:MISS
Other - First Name:CARINE
Other - Middle Name:A
Other - Last Name:CUVILLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:263 -07 73RD AVENUE #A1
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004
Mailing Address - Country:US
Mailing Address - Phone:718-347-8407
Mailing Address - Fax:
Practice Address - Street 1:263 -07 73RD AVENUE #A1
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004
Practice Address - Country:US
Practice Address - Phone:718-347-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034406 - 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01255Medicare PIN