Provider Demographics
NPI:1124126925
Name:CARROLL-BARBUTO, COLLEEN ELIZABETH (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:CARROLL-BARBUTO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BURHANS PL
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1201
Mailing Address - Country:US
Mailing Address - Phone:518-669-4668
Mailing Address - Fax:
Practice Address - Street 1:1 BURHANS PL
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1201
Practice Address - Country:US
Practice Address - Phone:518-669-4668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042142-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical