Provider Demographics
NPI:1902955578
Name:STERK, CAROL ROSCOE (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ROSCOE
Last Name:STERK
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 1:533 OAKHURST RD
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-4004
Mailing Address - Country:US
Mailing Address - Phone:914-698-5421
Mailing Address - Fax:914-698-0001
Practice Address - Street 1:650 HALSTEAD AVE STE 103
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2743
Practice Address - Country:US
Practice Address - Phone:914-263-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO18510-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3300108OtherOXFORD HEALTH PLANS