Provider Demographics
NPI:1588759559
Name:GALATZAN, CAROLYN N (MSW, LCSW-R)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:N
Last Name:GALATZAN
Suffix:
Gender:F
Credentials:MSW, LCSW-R
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:N
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW-R
Mailing Address - Street 1:3 TIOGA BLVD STE 5
Mailing Address - Street 2:C/O THE CENTER FOR PSYCHOLOGICAL SERVICES
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-4150
Mailing Address - Country:US
Mailing Address - Phone:607-785-4156
Mailing Address - Fax:607-625-4438
Practice Address - Street 1:3 TIOGA BLVD STE 5
Practice Address - Street 2:C/O THE CENTER FOR PSYCHOLOGICAL SERVICES
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-4150
Practice Address - Country:US
Practice Address - Phone:607-785-4156
Practice Address - Fax:607-625-4438
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028677-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004657Medicare ID - Type Unspecified