Provider Demographics
NPI:1861269201
Name:CARABALLO, YARITZA MARIE
Entity type:Individual
Prefix:
First Name:YARITZA
Middle Name:MARIE
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YARITZA
Other - Middle Name:MARIE
Other - Last Name:CARABALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1413 STONY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2214
Mailing Address - Country:US
Mailing Address - Phone:631-444-0101
Mailing Address - Fax:631-444-0102
Practice Address - Street 1:1413 STONY BROOK RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2214
Practice Address - Country:US
Practice Address - Phone:631-444-0101
Practice Address - Fax:631-444-0102
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator