Provider Demographics
NPI:1982745972
Name:CAFFERY, EILEEN ALANNA (LCSW)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:ALANNA
Last Name:CAFFERY
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 1:1050 HALLOCK AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1214
Mailing Address - Country:US
Mailing Address - Phone:631-474-0382
Mailing Address - Fax:631-474-0382
Practice Address - Street 1:1050 HALLOCK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1214
Practice Address - Country:US
Practice Address - Phone:631-474-0382
Practice Address - Fax:631-474-0382
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044197-1 R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY043417OtherVALUE OPTIONS INSURANCE
NY7484727OtherGHI INSURANCE
NYN5M661Medicare ID - Type Unspecified