Provider Demographics
NPI:1861406993
Name:GARRETT, CAROL (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2293
Mailing Address - Country:US
Mailing Address - Phone:631-385-0037
Mailing Address - Fax:631-385-1776
Practice Address - Street 1:900 WALT WHITMAN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2293
Practice Address - Country:US
Practice Address - Phone:631-385-0037
Practice Address - Fax:631-385-1776
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW R0413181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1C101Medicare ID - Type Unspecified