Provider Demographics
NPI:1053300772
Name:DESCUTNER, CAROL J (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:DESCUTNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5722
Mailing Address - Country:US
Mailing Address - Phone:716-633-4811
Mailing Address - Fax:
Practice Address - Street 1:1967 WEHRLE DR STE 4
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8452
Practice Address - Country:US
Practice Address - Phone:716-432-7948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-15
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011499103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical