Provider Demographics
NPI:1447840319
Name:ESTUPINAN, ALBA CAROLA (LMSW)
Entity type:Individual
Prefix:MS
First Name:ALBA
Middle Name:CAROLA
Last Name:ESTUPINAN
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 1:83 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2520
Mailing Address - Country:US
Mailing Address - Phone:347-531-3241
Mailing Address - Fax:
Practice Address - Street 1:408 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3518
Practice Address - Country:US
Practice Address - Phone:631-874-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111116-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker