Provider Demographics
NPI:1558108076
Name:HYDE, CARRIE ANN (LCSW-R)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:HYDE
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 1:500 ODELL AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2137
Mailing Address - Country:US
Mailing Address - Phone:607-759-2188
Mailing Address - Fax:
Practice Address - Street 1:203 COURT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-3601
Practice Address - Country:US
Practice Address - Phone:607-772-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health