Provider Demographics
NPI:1073308292
Name:MIDBOE, CAROLYN FAYE (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:FAYE
Last Name:MIDBOE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 HATTON HILL CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78725-1761
Mailing Address - Country:US
Mailing Address - Phone:737-932-0748
Mailing Address - Fax:
Practice Address - Street 1:900 HATTON HILL CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78725-1761
Practice Address - Country:US
Practice Address - Phone:737-932-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX615321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical