Provider Demographics
NPI:1194902478
Name:CARL, ELIZABETH S (LCSW CASAC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:S
Last Name:CARL
Suffix:
Gender:F
Credentials:LCSW CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 SOUTH MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4514
Mailing Address - Country:US
Mailing Address - Phone:917-972-8260
Mailing Address - Fax:845-323-4023
Practice Address - Street 1:356 S MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4514
Practice Address - Country:US
Practice Address - Phone:917-972-8260
Practice Address - Fax:845-323-4023
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3817101YA0400X
NYR038096 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01727251Medicaid
NY01727251Medicaid