Provider Demographics
NPI:1861567547
Name:MCINTYRE, CAROLYN ELLA (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ELLA
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
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Mailing Address - Street 1:62 MONTAGUE ST
Mailing Address - Street 2:#3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3375
Mailing Address - Country:US
Mailing Address - Phone:917-757-6542
Mailing Address - Fax:718-797-3193
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:SUITE 410 B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-0103
Practice Address - Country:US
Practice Address - Phone:917-757-6542
Practice Address - Fax:718-797-3193
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY036137-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical