Provider Demographics
NPI:1972902963
Name:MACAVOY, CAROLYN PEARL (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:PEARL
Last Name:MACAVOY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3410
Mailing Address - Country:US
Mailing Address - Phone:518-270-2646
Mailing Address - Fax:517-270-2707
Practice Address - Street 1:1641 3RD ST FL 2
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-1539
Practice Address - Country:US
Practice Address - Phone:518-463-8869
Practice Address - Fax:518-270-2707
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091489-011041C0700X
NY0914891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical