Provider Demographics
NPI:1124247283
Name:FREEMAN-CARROLL, NANCY MINA (PSYD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MINA
Last Name:FREEMAN-CARROLL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:MINA
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:350 CENTRAL PARK W
Mailing Address - Street 2:13E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6547
Mailing Address - Country:US
Mailing Address - Phone:212-665-0442
Mailing Address - Fax:
Practice Address - Street 1:350 CENTRAL PARK W
Practice Address - Street 2:13E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6547
Practice Address - Country:US
Practice Address - Phone:212-665-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012527-1103T00000X, 103TA0400X, 103TA0700X, 103TC0700X, 103TF0000X, 103TF0200X, 103TH0100X, 103TM1800X, 103TP0814X, 103TP2701X, 103TS0200X
NY012527-01103TC1900X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV30261Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST