Individual provider Active NPI

Clementina Maria Carnazza, LCSW

  • Social Worker
  • Island Park, NY
National Provider Identifier
1366743015
Registry record updated Nov 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
R0575431 Issued in NY
Practice address
222 Harrison Ave
Island Park, NY 11558-1310
Phone
(516) 897-1915
NPI assigned
Nov 11, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X R0575431 NY Primary

Addresses

Primary practice location

222 Harrison Ave
Island Park, NY 11558-1310

Mailing address

222 Harrison Avenue
Island Park, NY 11558
Phone (516) 897-1915

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
R0575431NYMDSocial Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289433600000",
    "number": "1366743015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 HARRISON AVENUE",
            "city": "ISLAND PARK",
            "state": "NY",
            "postal_code": "11558",
            "telephone_number": "516-897-1915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 HARRISON AVE",
            "city": "ISLAND PARK",
            "state": "NY",
            "postal_code": "115581310",
            "telephone_number": "516-897-1915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARNAZZA",
        "first_name": "CLEMENTINA",
        "middle_name": "MARIA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-11",
        "last_updated": "2010-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "R0575431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Island Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.