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Individual

MS. CAROL ELAINE MANDARINO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW CASAC

Contact information

Practice address
233 UNION AVE, HOLBROOK, NY 11741
(631) 220-4048
Mailing address
68 TIMBER RIDGE DR, HOLTSVILLE, NY 11742
(631) 220-4048

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R054256
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02751760
NY
01
11531727
CAQH
NY
01
563095
VALUE OPTIONS
NY
Enumeration date
04/04/2007
Last updated
07/08/2007
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