Provider Demographics
NPI:1962059790
Name:CARTY, KATHLEEN (MS)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CARTY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LOMBARDI RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1314
Mailing Address - Country:US
Mailing Address - Phone:914-260-2197
Mailing Address - Fax:
Practice Address - Street 1:719 W NYACK RD STE 43
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2241
Practice Address - Country:US
Practice Address - Phone:914-863-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101840-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health