Provider Demographics
NPI:1447532221
Name:CARRILLO-STERN, GENOVEVA ADRIANA (LCSW)
Entity type:Individual
Prefix:MS
First Name:GENOVEVA
Middle Name:ADRIANA
Last Name:CARRILLO-STERN
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 1:15 DOW AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3320
Mailing Address - Country:US
Mailing Address - Phone:516-385-8984
Mailing Address - Fax:
Practice Address - Street 1:13844 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1933
Practice Address - Country:US
Practice Address - Phone:718-263-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0718461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical