Provider Demographics
NPI:1861737827
Name:CARROLL, DEBORAH MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARIE
Last Name:CARROLL
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 1:175 E 96TH ST
Mailing Address - Street 2:APT 8T
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6200
Mailing Address - Country:US
Mailing Address - Phone:212-369-6725
Mailing Address - Fax:
Practice Address - Street 1:175 E 96TH ST
Practice Address - Street 2:APT 8T
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6200
Practice Address - Country:US
Practice Address - Phone:212-369-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070608-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical