Provider Demographics
NPI:1134267610
Name:MUNICH, CARRIE BROOKE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:BROOKE
Last Name:MUNICH
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 1:3401 SEAWANE DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5545
Mailing Address - Country:US
Mailing Address - Phone:516-546-7700
Mailing Address - Fax:
Practice Address - Street 1:230 HANSE AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-4648
Practice Address - Country:US
Practice Address - Phone:516-546-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067227-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01476806Medicaid
NYW8D361Medicare ID - Type Unspecified