Provider Demographics
NPI:1316715428
Name:SMALLWOOD, CAROLYN (P115032)
Entity type:Individual
Prefix:PROF
First Name:CAROLYN
Middle Name:
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:P115032
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4913
Mailing Address - Country:US
Mailing Address - Phone:917-588-7541
Mailing Address - Fax:
Practice Address - Street 1:2020 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4913
Practice Address - Country:US
Practice Address - Phone:917-588-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP115032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health