Individual
CARMEN R CEBALLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW-R
Contact information
Practice address
100 BROADHOLLOW RD STE 108, FARMINGDALE, NY 11735-4813
(631) 769-7763
(631) 769-7763
Mailing address
100 BROADHOLLOW RD STE 108, FARMINGDALE, NY 11735-4813
(631) 769-7763
(631) 769-7763
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
076791
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12769900
CAQH
—
Enumeration date
11/15/2006
Last updated
11/17/2019
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