1861567547 NPI number — MS. CAROLYN ELLA MCINTYRE LCSW-R

Table of content: MS. CAROLYN ELLA MCINTYRE LCSW-R (NPI 1861567547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861567547 NPI number — MS. CAROLYN ELLA MCINTYRE LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCINTYRE
Provider First Name:
CAROLYN
Provider Middle Name:
ELLA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861567547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62 MONTAGUE ST
Provider Second Line Business Mailing Address:
#3A
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11201-3375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-757-6542
Provider Business Mailing Address Fax Number:
718-797-3193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 COURT ST
Provider Second Line Business Practice Location Address:
SUITE 410 B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11242-0103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-757-6542
Provider Business Practice Location Address Fax Number:
718-797-3193
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  036137-R , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com