Provider Demographics
NPI:1962136267
Name:CARR, KATHERINE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2614
Mailing Address - Country:US
Mailing Address - Phone:917-676-3859
Mailing Address - Fax:
Practice Address - Street 1:20 RIVERLEIGH AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3674
Practice Address - Country:US
Practice Address - Phone:631-239-7344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110452101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor