Provider Demographics
NPI:1700607397
Name:IDOLYN V. CARNAHAN, LICSW, PLLC
Entity type:Organization
Organization Name:IDOLYN V. CARNAHAN, LICSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:IDOLYN
Authorized Official - Middle Name:VILLIOTTI
Authorized Official - Last Name:CARNAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-718-0937
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-0111
Mailing Address - Country:US
Mailing Address - Phone:603-718-0937
Mailing Address - Fax:
Practice Address - Street 1:1097 MAIN ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2646
Practice Address - Country:US
Practice Address - Phone:603-718-0937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty