Provider Demographics
NPI:1033233531
Name:THEA, CAROL S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:S
Last Name:THEA
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 1:151 E 80TH ST
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0442
Mailing Address - Country:US
Mailing Address - Phone:212-861-3308
Mailing Address - Fax:212-517-9323
Practice Address - Street 1:151 E 80TH ST
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0442
Practice Address - Country:US
Practice Address - Phone:212-861-3308
Practice Address - Fax:212-517-9323
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO218501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical