Provider Demographics
NPI:1780131664
Name:BEN REUBEN, CAROLYN VELLA (LMSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:VELLA
Last Name:BEN REUBEN
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 1:114 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1334
Mailing Address - Country:US
Mailing Address - Phone:014-699-7902
Mailing Address - Fax:
Practice Address - Street 1:9 W PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2018
Practice Address - Country:US
Practice Address - Phone:914-668-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080206-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical